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^cljool  of  Bental  anti  d^ral  burger? 


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3^cferente  ILtbrarp 


DENTAL  MEDICINE. 


GORGAS. 


STANDARD  WORKS 

FOR  DENTAL  STUDENTS  AND  PRACTITIONERS. 

Published  by  P.  BLAKISTON,  SON  &  CO. 


OO 


Harris. — The  Principles  and  Practice  of  Dentistry.     1 2th  Edition.     Thor- 
oughly Revised  and   Enlarged.     By  Prof.  F.   J.  S.  Gorgas.     1086 

Illustrations.     1225  Pages, Cloth,  $7.00;  Leather, 

Harris. — Dictionary  of  Medicine,  Dentistry,  and  Collateral  Sciences.     5th 

Edition.     Revised  by  Prof.  F.  J,  S.  Gorgas,    .    .  Cloth,  ^5. 00;  Sh.,  6.00 
Richardson. — Mechanical  Dentistry.     4th  Edition,  .    .  Cloth,  $4.50;  Sh.,  5.50 
Potter.— Compend  of  Anatomy.     New  5th  Edition.     Illustrated  by  Litho- 
graph Plates  and  many  Wood  Cuts, Cloth,  i.oo 

Talbot. — Irregularities  of  the   Teeth  and  their  Treatment.     2d  Edition, 

234  Illustrations, Cloth,  1.50 

Blodgett. — Dental  Pathology.     Illustrated, Cloth,  1.75 

Buxton. — Anaesthetics.     Illustrated, Cloth,  1.25 

Fillebrown. — Text-book  of  Operative  Dentistry.     Illustrated,  .    .    .  Cloth,  2.50 

Taft.— Operative  Dentistry.    4th  Ed.    136  Illustrations.    Cloth,  ^4.25 ;  Sh.,  5.00 

Leber  and  Rottenstein. — Dental  Caries, Paper,  75c.;  Cloth,  1.25 

Sansom. — Chloroform:  Its  Administration,  etc.,  .    .    .  Paper,  75c.;  Cloth,  1.25 

White. — The  Mouth  and  Teeth.     Illustrated, Cloth,  .50 

Barrett. — Dental  Surgery.     2d  Edition, Cloth,  1.25 

Gorgas. — Dental  Materia  Medica  and  Therapeutics.     4th  Edition,  .  Cloth,  3.50 

Heath. — Injuries  and  Diseases  of  the  Jaw^s.     3d  Edition.     lUus.,    .  Cloth,  4.50 

Heath. — Lectures  on  Certain  Diseases  of  the  Javs^s.     Illustrated,   .  Boards,  i.oo 

Kirkes. — Physiology.     12th  Edition.     Illustrated,  .  Cloth,  ^4.00;  Leather,  5.00 

Tomes. — Dental  Surgery.     Illustrated.     3d  Edition, Cloth,  5.00 

Torhes. — Dental  Anatomy.     3d  Edition.     Illustrated,    ......  Cloth,  4.00 

Stocken. — Dental  Materia  Medica.     3d  Edition, Cloth,  2.50 

Yeo. — Manual  of  Physiology.     5th  Edition.     321  Illus.,  Cloth,  $3.00;  Sh.,  3.50 

Flagg. — Plastics  and  Plastic  Filling.     4th  Edition, Cloth,  4.00 

Potter. — Compend  of  Materia  Medica.     Sth  Edition.     Illustrated,   .  Cloth,  i.oo 

Brubaker. — Compend  of  Physiology.     Illustrated.     6th  Edition,  .  .  Cloth,  i.oo 

Holden. — Anatomy.     5th  Edition.     208  Illus.,  .  .    .    .Oil  Cloth  Binding,  4.50 
Potter. — Hand-Book  of  Materia  Medica,  Pharmacy  and  Therapeutics.     3d 

Edition.     Revised, Cloth,  ^4.00;  Leather,  '5.00 

^^°  Catalogues  of  Medical  atid  Denial  Books  sent  upon  application. 


DENTAL  MEDICINE 


A  MANUAL 


DENTAL  MATERIA  MEDICA 


AND  THERAPEUTICS. 


FERDINAND  J.  S.  GORGAS,  A.  M.,  M.  D.,  D.  D.  S., 

Editor  of  "Harris'  Principles  and  Practice  of  Dentistry,"  and  "Harris'  Diction- 
ary OF  Medical  Terminology  and  Dental  Surgery,"  Professor  of  the 
Principles  of  Dental  Science,  Dental  Surgery,  etc.,  in  the 
University  of  Maryland,  Baltimore. 


FO UR  TH  EDITION.     RE  VISED  AND  ENLARGED. 


PHILADELPHIA : 

P.   BLAKISTON,  SON  &  CO., 

No.   IOI2  Walnut  Street. 
i8qi. 


(l(^n 


Entered  according  to  Act  of  Congress,  in  tlie  year  1 891,  by 

P.  BLAKISTON,  SON  &  CO., 

In  the  Office  of  the  Librarian  of  Congress,  at  Washington,  D.  C. 


PRESS  OF 

THE  JA9.  B.  RODGERS  PRINTrNQ  00. 

62  8l  64  NORTH  SIXTH  ST.. 

PHILADELPHIA. 


PREFACE  TO  FOURTH  EDITION. 


In  presenting  a  fourth  edition  of  the  "  Dental  Medicine  "  to 
the  dental  profession,  the  author  desires  to  express  his  grate- 
ful appreciation  for  the  favor  with  which  every  one  of  the 
preceding  editions  has  been  received,  and  the  kind  notices 
they  have  elicited. 

The  history  of  the  Third  Edition  has  been  similar  to  that 
of  the  first  and  second  editions,  every  copy  having  been 
disposed  of  some  months  before  the  present  edition  was  ready 
for  publication. 

So  much  has  been  added  to  this  (fourth)  edition,  in  order 
to  bring  the  work  up  to  the  present  status  of  dental  materia 
medica  and  therapeutics,  that  the  author  cherishes  the  hope 
that  its  value  as  a  text-book  and  work  of  reference,  has  been 
greatly  increased  over  that  of  former  editions. 

Considerable  matter  has  been  added  to  Diagnosis  of  the 
Affections  of  the  Mouth,  the  different  Remedial  Agents,  the 
various  substances  classed  as  dental  materia  medica,  with  their 
medicinal  properties,  action,  dental  uses  and  mode  of  applica- 
tion ;  among  the  number — Arsenious  Acid,  Carbolic  Acid, 
Aromatic  Sulphuric  Acid,  Tannic  Acid,  Chloroform,  Nitrous 
Oxide,  Chloral,  Antipyrene,  Antifebrin,  Bichloride  of  Mercury, 
Peroxide  of  Hydrogen,  Creolin,  Chloride  of  Methyl.  Sulpho- 
nal,  etc.,  etc. 

A  new  chapter  has  been  added  on  the  use  of  Antiseptics  in 
Dental   Practice,  which   includes  the   Sterilization  of  Dental 


6  PREFACE  TO  FOURTH  EDITION. 

and  Surgical  Instruments.  The  list  of  new  antiseptics,  disin- 
fectants, germicides  and  hypnotics,  etc,  referred  to  in  the 
present  edition,  includes,  Aristol,  Bromol,  Campho-Phenique, 
Phenol-Camphor,  Chloralamide,  Synthetic  Carbolic  Acid, 
Biniodide  of  Mercury,  Iodine  Tri-Chloride,  Chloral-Phenol, 
lodophenacetin,  Lysol,  Bichloride  of  Methylene,  Microcidine, 
Myrtol,  Phenacetine,  Pyoktanin,  Salol,  Sodium  Silico-Fluoride, 
Salipyrene ;  also  the  effects  of  the  Vermilion  of  Vulcanized 
Rubber  on  the  Mouth,  Test  Papers  for  Dentists,  List  of  New 
Remedies,  Rendering  the  Hands  Aseptic,  Organic  and  Inor- 
ganic Acids,  and  Carbon  Compounds,  Alkalies  and  Alkaline 
Earths. 

A  number  of  new  and  valuable  formulae  have  also  been 
added,  and  the  Index  to  "  Dental  Diseases  and  Remedies  " 
has  been  correspondingly  increased. 

Ferdinand   J.  S.  Gorgas. 
Hamilton  Terrace,  Baltimore. 
October  i,  i8gi. 


PREFACE  TO  THIRD  EDITION. 


In  presenting  a  third  edition  of  the  "  Dental  Medicine," 
the  author  trusts  that  the  new  matter  it  contains,  comprising 
nearly  one  hundred  pages,  will  add  to  its  value  as  a  text- 
book, and  increase  its  usefulness  to  the  dental  practitioner. 
The  universal  favor  with  which  the  preceding  editions  have 
been  received,  is  gratefully  appreciated,  and  the  fact  that, 
like  the  "  Principles  and  Practice  of  Dentistry,"  the  second 
edition  of  the  "  Dental  Medicine  "  was  exhausted  for  several 
months  before  the  present  one  could  be  prepared  for  publi- 
cation, is  an  evidence  of  its  favorable  reception.  What  the 
author  deems  an  improvement,  has  been  made  in  the  arrange- 
ment of  a  portion  of  the  subject  matter  of  the  present  edition, 
and  considerable  additions  have  been  made  to  a  number  of 
subjects,  among  them  being  the  following :  Diagnosis  of  the 
Affections  of  the  Mouth,  General  and  Local  Anaesthesia, 
the  Action  of  Arsenious  Acid  as  a  Devitalizing  Agent,  etc., 
etc. 

In  the  new  matter  will  be  found :  The  Action  of  Antisep- 
tic Agents,  The  Proper  use  of  Antiseptics  in  Dental  Practice, 
The  value  of  Germicides  and  Disinfectants,  The  Digestibility 
of  Foods,  Incompatibility,  etc.,  etc.  To  the  Dental  Materia 
Medica  and  Therapeutics  have  been  added  such  agents  as 
lodolj  Hydronaphthol,  Bromides  of  Ammonium,  Calcium, 
Lithium,  Sodium,  Benzoates,  Lithium  and  its  Preparations, 
Phosphates  and  Phosphites,  Creolin,  Cresylic  Acid,  Hydrate 


PREFACE  TO  THIRD  EDITION. 


of  Amylene,  Herbst's  Obtundent,  Lanolin,  Kandol,  Methyl 
Chloride,  Nux  Vomica,  Turpentine,  Rhubarb,  Paraldehyde, 
Sodium  and  its  Preparations,  Sulfanol,  Stenocarpine,  Sali- 
cylates, Serpentaria,  Prunus  Virginiana,  Naphthalene,  Guiacol, 
Cod-liver  Oil,  Colchicum,  Sulphite  of  Aluminium,  Anthemis, 
Antifebrin,  Antipyrene,  Aloes,  Acetanilide,  Sulphurous  Acid, 
Ammonia  and  its  Preparations,  Cresylicum,  Aromatic  Bitters, 
etc.,  etc.,  etc.  A  number  of  new  formulas  have  also  been 
added,  and  the  Index  to  "  Dental  Diseases  and  Remedies " 
has  been  correspondingly  increased. 

Ferdinand  J.   S.  Gorgas. 

Hamilton  Terrace,  Baltimore. 


PREFACE  TO  THE  FIRST  EDITION. 


This  work  has  been  prepared  by  the  author  in  deference 
to  many  requests  from  former  pupils,  and  has  been  compiled 
from  lectures  delivered  by  him  in  dental  institutions  during 
the  past  twenty-five  years,  and  notes  obtained  from  the 
standard  works  on  Materia  Medica  and  Therapeutics,  and 
also  from  personal  experience  as  a  dental  practitioner  and 
teacher. 

While  the  author  claims  the  credit  of  the  compilation,  he 
does  not  claim  originality  in  the  sources,  derivations,  medical 
properties  and  action  of  the  various  articles  of  dental  materia 
medica  which  are  given  in  this  work. 

His  intention  has  been  to  present  not  alone  his  own  ideas 
as  to  the  particular  application  of  remedies,  but  also  those 
of  well-known  and  acknowledged  authorities,  and  in  such  a 
manner  as  may  be  of  service  to  the  dental  student  in  acquiring 
a  knowledge  of  this  important  branch  of  his  profession ;  hence 
nothing  has  been  presented  in  this  work  that,  in  the  author's 
opinion,  is  not  applicable  to  dental  practice,  and  that  will  not 
be  of  benefit  to  the  dental  student. 

The  dental  formulary  comprises  many  valuable  combina- 
tions, and  credit  has  been  given,  in  every  case  where  it  was 
possible,  to  the  authors  of  the  different  preparations. 

The  necessity  for  an  American  work  of  this  kind  has  long 
been  apparent,  and  after  years  of  delay  and  promises  the 
author  gratefully  dedicates  this  work  to  his  former  pupils  in 
the  dental  institutions  with  which  he  has  been  and  is  now 
connected,  in  the  capacity  of  a  teacher. 

Hamilton  Terrace,  Bai,timork. 


CONTENTPS. 


PAGE 

Prefaces 5-9 

Definition  of  Subjects 13 

Action  of  Medicinal  Substances 13 

Inflammation,  with  Special  Reference  to  Oral  Mucous  Membrane, 
Important  Points  in  Diagnosing  Affections  of  the  Mouth,  with  a 

Synopsis  of  Treatment 41 

Characteristic  Indications  of  the  Tongue 71 

Digestibility  of  Foods 71 

Abbreviations,  with  Latin  and  English  Terms 73 

Approximate  Measurements 75 

Fineness  of  Powder 75 

Weights  and  Measures • 76 

Metric  or  French  Decimal  System  of  Weights  and  Measures    ...  76 

Rules  for  Regulating  Doses 80 

Topical  Remedies 82 

The  Endermic  Method 82 

The  Hypodermic  Method 82 

Setons  and  Issues 83 

General  Bloodletting 84 

Local  Bloodletting  by  Leeching,  Cupping  and  Scarifications    ...  84 

Electricity  as  a  Therapeutic  Means  in  the  Treatment  of  Disease  .    .  85 

Incompatibility 91 

Table  of  Doses  of  all  Officinal  Medicines,  Expressed  in  Terms  of 
Both  the  Apothecaries'  and  the  Decimal  Metric  System  of 

Weights  and  Measures 93 

Poisons — Symptoms  and  Antidotes 104 

The  Pulse in 

Pulsation  per  Minute  at  Various  Ages 112 

Respiration  at  Various  Ages 114 

Thermometers 114 

11 


12  CONTENTS. 


PAGE 


Table  of  Elementary  Substances Ii6 

Table  of  the  Solubility  of  Chemicals  in  Water  and  Alcohol  ....  117 

Classification  of  Medicinal  Substances 121 

Definitions  of  the  Various  Classes  of  Medicinal  Agents 121 

Forms  in  which  Medicinal  Substances  are  employed 151 

Source,  Derivation,  Medical  Properties  and  Action,  and  Therapeutic 
Uses  of  Medicinal  Substances  Employed  in  Dental  Practice  ; 

Together  with  their  Dental  Uses  and  Application    ....    4  155 

Administration  of  General  Anaesthetic  Agents 210 

The  Dangers  of  Anesthesia 220 

Preventive  Measures  Against  the  Dangers  of  Anaesthesia 220 

Treatment  of  Dangerous  Symptoms  of  Anaesthesia 220 

Methods  of  Resuscitation — Sylvester's  Method — Hall's  Ready  Method  221 

"                    "                Howard's  Method,  etc 223 

Local  Anaesthesia 235 

Rapid  Breathing  as  a  Pain  Obtunder 228 

Periods  for  the  Eruption  of  the  Teeth 505 

Authorities  Consulted 506 

Index  to  Dental  Formulary  and  Dental  Diseases 507 

General  Index 513 


DENTAL   MEDICINE. 


DEFINITION  OF  SUBJECTS. 

Materia  Medica  is  that  branch  of  medical  science  which  re- 
fers to  and  describes  the  methods  and  substances  known  as 
"  medicinal  agents/'  which  are  employed  in  the  prevention 
and  treatment  of  disease. 

Therapeutics  is  that  branch  of  medical  science  which  com- 
prises the  doctrine  of  the  management  of  disease.  Generally, 
however,  the  term  is  restricted  to  a  description  of  the  modus 
operandi  of  medicines,  or,  in  other  words,  their  use,  application 
and  effects  when  applied  in  the  treatment  of  various  morbid 
conditions.  An  accurate  knowledge  of  the  principles  and 
rules  which  govern  the  administration  and  action  of  medicinal 
substances  enables  the  practitioner  to  restore  disordered  func- 
tions, and  to  so  impress  the  organism  as  to  maintain  harmoni- 
ous conditions,  by  means  of  which  the  various  functions,  in  a 
state  of  health,  are  intimately  connected  by  relation  and 
sympathy. 

Some  medicinal  agents  exert  their  influence  on  primary 
nourishment,  converting  food,  by  digestion,  into  the  substance 
of  organic  beings,  while  other  remedies,  without  interfering 
with  digestion,  by  a  modification  of  the  process  of  assimilation 
exert  a  destructive  influence  upon  the  tissues.  Some  medi- 
cinal agents  affect  the  nervous  system,  and  others  are  so  irri- 
tant in  their  effects  as  to  cause  their  speedy  expulsion  ;  while 
others,  again,  have  a  particular  affinity  for  certain  organs,  and 
are  eliminated  by  them,  the  effects  ceasing  as  soon  as  the 
evacuation  is  completed.  Other  medicinal  agents  prevent 
septic  decomposition  and  the  growth  of  micro-organisms. 

What  are  known  as  topical  or  external  remedies  act  directly 
upon  the  parts  to  which  they  are  applied,  and  their  general 
effects  are  produced  through  the  nervous  system. 

13 


14  DENTAL   MEDICINE. 


\ 


INFLAMMATION : 
WITH    SPECIAL    REFERENCE   TO    ORAL    MUCOUS    MEMBRANE. 

Definition  of  Conditions  Associated  with  Disturbances  of 
Nutritiofi. — Hyperczmia  signifies  superabundance  of  blood  in 
the  blood  vessels,  but  this  term  is  restricted  to  such  a  condition 
existing  in  a  definite  organ  or  portion  of  an  organ ;  hence 
hyperaemia  and  dilatation  of  blood  vessels  are  so  intimately 
connected  that  the  one  cannot  exist  without  the  other. 

It  is  also  necessary  that  the  capillaries  as  well  as  the  arteries 
and  veins  should  be  injected,  in  order  that  the  color  of  the 
region  so  affected  should  be  increased,  as  the  former  consti- 
tute a  dense  network,  which  traverses  the  entire  organ,  while 
the  latter  only  form  single  branches,  which  occupy  limited 
spaces. 

The  term  Plethora,  as  distinguished  from  hyperaemia,  signi- 
fies a  superabundance  of  blood  in  the  entire  circulatory  system. 
Active  hyperaemia  in  the  skin  and  mucous  membranes  is  char- 
acterized by  a  diffuse  bright-red  coloration,  the  parts  so 
affected  having  a  higher  temperature  than  those  around  them. 
The  diffuse  coloration  is  caused  by  the  bright-red  arterial 
blood  which  fills  the  capillaries ;  and  the  elevation  of  the 
temperature  is  due  to  the  presence  of  the  blood,  which  heats 
the  skin  or  mucous  membranes,  and  the  more  quickly  the 
blood  circulates  the  warmer  the  tissue  becomes,  until  at  length 
the  highest  degree  of  blood  heat  is  accomplished. 

Passive  hyperaemia  denotes  a  condition  of  the  tissues  char- 
acterized by  a  diffuse  venous,  not  arterial,  coloration  and  a 
relatively  low  temperature.  In  passive  hyperaemia  the  capil- 
laries are  also  dilated,  but  the  blood  current  through  them  is 
retarded ;  hence  the  tissues  so  affected  are  of  a  venous  color 
instead  of  the  bright-red  or  arterial  color  of  active  hyperaemia. 

The  term  Ancemia  signifies  a  condition  in  which  there  is  an 
abnormal  diminution  in  the  amount  of  blood,  and  is  the 
opposite  to  that  of  Plethora,  being  characterized  by  a  pale  face, 
lips,  gums  and  mucous  membranes.  But  the  normal  amount 
of  blood  may  be  present,  and  yet  the  characteristic  paleness 


INFLAMMATION.  15 


denote  an  anaemic  condition,  for  the  reason  that  the  number  of 
red  blood  corpuscles  are  decreased  and  replaced  by  white 
blood  corpuscles,  or  by  blood  plasma. 

Again,  the  paleness  of  an  anaemic  condition  may  be  due  to 
a  deficiency  of  the  red  coloring  matter  of  the  red  blood  cor- 
puscles. A  permanent  contraction  of  the  blood  vessels  may 
also  cause  a  paleness  of  the  face,  lips,  gums  and  mucous 
membranes. 

The  term  IschcBinia  is  also  employed  to  denote  local 
poverty  of  the  blood,  a  deficiency  of  the  coloring  matter 
(haemoglobine). 

The  direct  cause  of  hyperaemia,  and  also  of  ischaemia,  is  a 
change  of  calibre  of  the  blood  vessels,  namely,  dilatation  and 
contraction.  This  dilatation  and  contraction  of  the  blood 
vessels  is  due  to  the  elastic  and  contractile  elements  of  the 
sheaths  and  walls  of  the  arteries  and  veins,  and  both  the  dila- 
tation and  contraction  are  regulated  by  the  spinal  cord,  through 
the  medium  of  the  vaso -motor  nerves.  It  is  a  common 
opinion  that  hyperaemia  cannot  exist  without  the  influence 
of  the  vaso-motor  nerves. 

Irritation  indicates  the  condition  of  a  tissue  in  which  there 
exists  an  excess  of  vital  action,  on  account  of  the  disordered 
state  of  the  nerves  of  the  affected  part  or  organ.  It  is  com- 
monly manifested  by  such  symptoms  as  increased  circulation, 
warmth  and  sensibility,  and  functional  disturbance  of  a  greater 
or  less  degree. 

What  inflammation  is  to  the  vascular  system,  irritation  is  to 
the  nervous  system,  and  the  difference  between  these  two  con- 
ditions is  defined  by  the  explanation  that  the  latter  terminates 
when  the  former  begins.  Irritation  is  generally  excited  by 
the  action  of  certain  stimuli  upon  organic  tissues,  by  which 
the  sensibility  of  such  tissues  is  perverted  and  the  circulation 
deranged ;  such  pathological  conditions  when  they  are  not  the 
precursor  of  inflammation,  soon  passing  off,  and  the  affected 
tissue  regaining  its  normal  state,  when  the  exciting  cause 
ceases  to  operate.  Irritation  may  be  direct  and  indirect — 
direct  when  the  irritation   manifests  itself  at  the  point  where 


16  DENTAL   MEDICINE. 


the  impression  to  which  it  owes  its  origin  is  received ;  indirect 
when  the  irritation,  through  sympathy  and  reflex  action,  is 
transmitted  to  more  or  less  remote  parts  or  organs.  An 
example  of  direct  irritation  may  be  adduced  by  friction  upon 
the  skin  or  mucous  membrane  of  the  mouth  sufficient  to  cause 
redness  in  the  first  tissue,  and  increased  coloration  in  the 
second;  or  indirect  irritation,  in  the  convulsions  attending 
difficult  dentition,  the  irritation  being  communicated  to  the 
brain  by  the  fifth  pair  of  nerves,  and  from  thence  to  the  nerves 
of  the  voluntary  muscles,  the  seat  of  the  spasmodic  action. 
Dental  caries  also  affords  another  example  of  indirect  irrita- 
tion, in  the  form  of  neuralgic  pains  of  the  temple,  face,  ear, 
eye,  and  of  even  more  remote  parts,  such  as  the  uterus. 

The  effect  of  irritation  upon  the  vascular  system  is  mani- 
fested by  dilatation  of  the  blood  vessels ;  but  the  immediate 
effect,  however,  of  a  slight  chemical  or  mechanical  irritant  is 
not  at  once  apparent  in  the  capillaries,  but  first  causes  contrac- 
tion of  the  smaller  arteries,  and  sometimes  of  the  veins,  such 
contraction  being  followed  by  dilatation,  the  immediate  cause 
of  which  is  yet  obscure.  It  is,  however,  supposed  to  be  the 
result  of  a  relaxation  or  a  temporary  paralysis  of  the  walls  of 
the  vessels,  a  condition  following  contraction,  and  which,  as  a 
consequence,  causes  a  decrease  of  their  resistance  to  the  pres- 
sure of  the  blood  within  them.  The  irritation  either  perverts 
the  function  of  the  nerves  of  the  vessels,  or  of  the  lining  cell 
substance  of  the  capillary  walls  ;  or  the  disturbance  is  due  to 
reflex  action. 

Inflammation  denotes  an  abnormal  process  or  condition 
characterized  by  certain  changes  of  texture,  which,  although 
uniform  in  type,  differ  widely  in  appearance,  and  terminate  in 
different  results,  according  to  the  nature  and  permanency  of 
the  causes  upon  which  such  a  condition  depends,  or  which 
have  given  rise  to  it. 

The  symptoms  of  inflammation  consist  of  the  phenomena 
which  accompany  the  textural  changes  characteristic  of  this 
condition,  and  its  pathology  the  textural  changes  which  occur 
during   the    continuance   of  this   condition.       The    essential 


INFLAMMATION.  17 


features  of  inflammation  are  an  increased  afflux  of  blood  to  the 
affected  part,  with  a  greatly  increased  tendency  to  cell  prolifer- 
ation and  tissue  formation. 

The  causes  of  inflammation  determine  in  a  great  degree  its 
treatment  on  account  of  the  influence  they  exert  upon  its 
destructive  tendency,  and  they  may  be  classified  as  those 
arising — 1st,  from  mechanical  violence;  2d,  from  irritating  and 
destructive  chemical  action  ;  3d,  from  poisonous  infection,  and 
the  effect  of  injurious  micro-organisms — the  latter  being 
regarded  as  "  immediate  determining  causes  of  the  more  de- 
structive phases  of  the  inflammatory  process."  When  inflam- 
mation owes  its  origin  to  an  evident  injury,  or  the  reverse,  it 
is  termed  traianatic,  or  idiopathic,  and  when  no  apparent  cause 
can  be  discovered  it  is  termed  spontaneous. 

The  causes  of  inflammation  are  divided  into  predisposing 
and  exciting. 

Among  the  more  important  predisposing  causes  are  im- 
poverisJied blood — defective  in  quality — such  as  may  result  from 
a  want  of  proper  food  and  of  fresh  air,  the  effects  of  such 
deprivations  being  manifested  in  the  case  of  a  neglected  child 
where  a  hard  swelling  occurs  in  the  cheek,  which,  after  a  few 
days,  presents  a  gangrenous  condition,  constituting  the  disease 
known  as  cancrum  oris  or  gangrcenopsis.  On  the  other  hand, 
an  habitual  excess  of  food  and  drink  is  also  a  predisposing 
cause  of  inflammation,  the  blood,  as  a  consequence,  being  im- 
paired, and  also  the  tissue  which  it  supplies.  Blood  poisoning 
is  also  another  predisposing  cause,  resulting,  it  may  be,  from 
the  presence  of  certain  diseases,  such  as  syphilis,  diabetes  mel- 
litus,  eczema,  etc.  A  local  hyperaemia,  constituting  the  first 
stage  in  the  development  of  inflammation,  may  result  from 
certain  poisons  in  the  blood,  which  cause  it  to  stagnate  in 
limited  areas,  through  an  inability  to  stimulate  the  heart  and 
blood  vessels.  Syphilitic  ulceration  of  the  mucous  membrane 
of  the  mouth  is  an  example  of  such  a  predisposing  cause. 
Weakened  vitality  of  parts  is  also  a  predisposing  cause  of  in- 
flammation, and  may  result  from  habitual  ill  feeding,  protracted 
illness,  over-work,  long  exposure  to  extreme  cold.  Parts  such 
2 


13  DENTAL   MEDICINE. 


as  the  mucous  membrane  of  the  mouth,  which  have  already- 
been  the  seat  of  inflammation,  are  prone  to  such  a  condition 
subsequently,  from  slight  provocation. 

Defective  or  perverted  nervous  supply  may  also  be  regarded 
as  a  predisposing  cause  of  inflammation.  Certain  forms  of 
skin  disease,  and  inflammatory  conditions  of  the  mucous 
membrane  of  the  mouth,  furnish  examples ;  also,  of  the  peri- 
osteum of  the  teeth,  resulting  in  severe  periodontitis  and 
alveolar  abscess. 

The  influence  of  cliinate  is  also  regarded  as  a  predisposing 
cause,  for,  in  tropical  regions,  inflammations  of  certain  organs, 
often  terminating  in  abscesses,  are  very  prevalent.  The  mid- 
summer and  fall  months  are  considered  to  be  more  favorable 
for  surgical  operations,  on  account  of  the  comparative  absence 
of  inflammatory  complications  at  such  times. 

Age  has  also  some  influence  as  a  predisposing  cause  of 
inflammation.  In  childhood  acute  hyperaemia  is  induced  by 
comparatively  slight  exciting  causes,  as  then  the  process  of 
nutrition  is  at  its  greatest  period  of  activity,  and  any  interrup- 
tion of  its  process  is  followed  by  derangement  of  health. 

The  effects  of  the  irritation  of  the  first  dentition  may  be  ad- 
duced as  an  example.  Old  age  induces  weakness  in  the  tissues 
and  decrease  of  power  of  resistance  to  the  exciting  causes  of 
inflammation. 

Exciting  Causes  of  Inflammation. — These  causes  may  all  be 
included  in  the  condition  known  as  irritation  of  the  tissues, 
resulting  from  irritants  of  various  kinds,  the  action  of  which 
is  immediate  in  producing  the  inflammatory  condition.  Ex- 
citing causes  may  be  divided  into  external^  which  are  easily 
recognized,  and  internal,  which  are  more  obscure,  and  are 
assisted  by  some  predisposition  of  the  organism. 

Cold  is  a  frequent  cause  of  inflammation,  and  its  effects  are 
due  to  sudden  changes  in  the  constitution  of  the  blood  from 
an  arrest  of  the  function  of  the  tissues,  temporary  in  its  nature, 
which  interferes  with  the  emunctory  action,  whereby  effete  and 
irritant  materials  which  should  be  eliminated  are  retained, 
and  poison  the  blood.     Heat  is  also  a  cause  of  inflammation, 


INFLAMMATION.  19 


its  effects  varying  from  a  slight  redness,  denoting  transient 
hyperaemia,  to  vesication,  either  superficial  or  deep.  When 
death  of  tissue  results  from  such  a  cause,  suppuration  ensues 
on  the  separation  of  the  eschar ;  and  when  there  is  a  loss  of 
cicatricial  power,  repair  by  granulation  and  suppuration 
(second  intention)  is  prevented.  The  inflammation  resulting 
from  simple  burns  and  scalds,  provided  no  eschar  is  formed, 
and  air  is  excluded,  soon  subsides. 

Mechanical  violence  excites  inflammation,  yet,  under  favor- 
able circumstances,  this  condition  resulting  from  an  incised 
wound,  is  soon  arrested,  owing  to  its  benign  form,  by  the  par- 
ticles of  lacerated  tissue  being  carried  away  by  the  blood  and 
the  subsequent  liquid  exudation,  while  those  that  remain  un- 
dergo liquefaction  and  absorption  by  the  lymphatics ;  hence, 
when  the  cut  surfaces  are  brought  and  retained  in  proper 
apposition,  speedy  union,  "  by  the  first  intention"  results. 
Union  by  "  first  intention"  is  induced  by  such  changes  as  cell- 
proliferation,  the  formation  of  new  capillaries,  and  the  genera- 
tion of  cicatricial  tissue.  It  is  only  when  the  vitality  of  the 
tissue  is  destroyed  and  foreign  matters  left  in  the  wound, 
especially  a  punctured  one,  caused  by  a  rough  or  rusty  instru- 
ment, that  there  are  complications.  The  tissues  themselves, 
when  they  lose  their  vitality,  become  irritants,  even  when  the 
dead  matter  is  very  minute.  A  boil  furnishes  an  example, 
the  core  of  which  is  composed  mainly  of  yellow,  elastic  fibres 
with  some*  leucocytes  or  pus  cells  in  the  meshes.  This  mass 
becomes  dead,  and  while  the  white  fibrous  element  liquefies 
and  mingles  with  the  pus,  the  yellow  fibres  remain  unchanged 
and  constitute  the  irritant  body,  to  the  presence  of  which  is  due 
the  suppurative  inflammation.  The  presence  of  a  clot  of  blood 
in  a  wound  may  prevent  union,  and  cause  pus  formation. 

Chemical  irritants  excite  inflammation  by  first  causing  in- 
creased redness,  which  steadily  extends  and  becomes  more 
intense  until  a  considerable  diameter  is  attained.  There  is 
also  increased  heat  and  fullness  of  the  part  affected,  and  an 
eschar  forms  as  the  result  of  the  action  of  the  chemical  agent 
upon  the  epidermis  in  the  case  of  the  skin,  or  the  corium  in 


20  DENTAL   MEDICINE. 


the  case  of  mucous  membrane,  the  depth  of  the  action  depend- 
ing upon  the  nature  of  the  chemical  irritant.  After  one  or 
two  days  the  narrow  circle  of  redness  disappears,  and,  after 
one  or  two  weeks,  the  eschar  separates,  disclosing  an  area  of 
smooth  cicatricial  tissue.  When  the  action  of  such  irritants  is 
slight,  repair  soon  follows,  without  the  formation  of  an  eschar; 
but  when  their  action  is  severe  enough  to  devitalize  the  tissue, 
the  sloughs  are  thrown  off  without  suppuration,  if  the  parts 
have  been  protected  from  the  air,  or  antiseptic  applications 
have  been  made. 

Mineral  irritants,  such  as  mercury  and  arsenic,  for  example, 
cause  inflammation  by  a  process  different  from  that  of  chemi- 
cal irritants.  The  inflammatory  action  of  mercury  and  arse- 
nious  acid  is  developed  only  after  the  poison  has  entered  the 
circulation,  and  a  certain  amount  has  been  received  by  the 
stomach,  when  active  inflammation  of  the  mouth  with  saliva- 
tion (mercurial  stomatitis)  supervenes,  if  the  agent  is  mercury, 
or  active  gastric  hypersemia  with  vomiting,  if  the  agent  is 
arsenic.  There  is  a  specific  poisonous  action  brought  about 
by  such  irritants,  on  account  of  the  tissues  of  the  mouth  and 
stomach  being  more  sensitive  to  the  influence  of  these  mineral 
poisons.  The  cause  of  this  peculiar  susceptibility  is  as  yet 
obscure. 

Micro-organisms  are  capable  of  exciting  inflammation  by 
direct  contact  with  tissues,  when  the  latter  are  exposed  by 
injury. 

Many  of  these  low  forms  of  life  are  indestructible  by  the 
most  extreme  heat  and  cold,  and  also  by  the  strongest  chem- 
ical agents.  And  whenever  the  oxygen  is  prevented  from 
entering  a  wound  these  micro-organisms  generate  with  great 
rapidity,  and  are  nourished  by  the  fluids  and  granulating  sur- 
faces which  surround  them.  The  chemical  and  vital  changes 
which  these  animal  materials  undergo  bring  about  putrefac- 
tion through  the  agency  of  fermentation,  and  certain  poison- 
ous combinations  are  thus  formed.  These  micro-organisms, 
therefore,  acting  as  a  poison,  decompose  the  materials  gener- 
ated for  repair,  and  thus  prevent  the  constructive  process; 


INFLAMMATION.  21 


they  also  act  as  a  putrefactive  ferment,  producing  septic  poisons 
destructive  in  their  action.  It  has  been  definitely  determined 
that  these  organisms,  although  present  in  every  destructive 
inflammation,  "  do  not  occur  in  the  blood  nor  in  the  tissues  of 
the  healthy  living  body  of  man  or  of  the  lower  animals." 
Diminished  vitality,  whatever  may  be  the  cause,  favors  the 
invasion  and  development  of  micro-organisms  in  the  form  of 
parasites. 

Symptoms  of  Inflammation. — The  coexistence  of  the  phe- 
nomena, redness  and  heat,  with  swelling  and/«m,  the  ordinary 
symptoms  of  inflammation,  may,  therefore,  be  considered  as 
sufficient  evidence  of  the  presence  of  the  inflammatory  condi- 
tion. The  absence,  however,  of  one  or  more  of  these  phe- 
nomena is  not  incompatible  with  the  existence  of  inflammation, 
for  the  increased  redness  and  heat  may  disappear  before  the 
inflammatory  process  ceases,  and  pain  be  sometimes  absent. 

The  redness  of  an  inflamed  part  is  usually  the  first  observ- 
able phenomenon,  and  one  of  the  most  characteristic  symptoms 
of  inflammation,  and  one  also  that  is  rarely  absent.  It  varies 
in  intensity,  according  to  the  degree  of  the  inflammatory 
process,  the  nature  of  the  part  affected,  the  condition  of  the 
system,  and  the  cause  of  the  inflammation.  Of  a  light  tint  in 
the  early  stage,  it  becomes  deeper  as  the  inflammatory  process 
increases  in  degree,  until  every  grade,  almost,  of  redness  is 
observable,  ending  in  a  deep  crimson  or  even  purple.  It  may 
appear  in  points,  streaks,  in  minute  ramifications,  or  be  quite 
uniform  over  the  entire  surface  affected.  Usually  it  is  more 
intense  in  one  spot,  gradually  fading  as  it  recedes,  until  lost  in 
the  surrounding  healthy  tissue  ;  in  other  cases  the  redness  has 
an  abrupt  boundary,  and  is  of  equal  intensity  over  its  entire 
area.  The  brighter  hue  usually  attends  ordinary  active  in- 
flammation ;  the  darker  hue  that  form  of  inflammation  pro- 
ceeding from  some  specific  cause,  or  associated  with  a  gangre- 
nous tendency.  The  redness  of  inflammation  is  caused  by  the 
increased  amount  of  blood  entering  the  vessels  of  the  part, 
and  remaining  there  for  a  longer  time  than  is  natural  under 
other  conditions. 


22  DENTAL   MEDICINE. 


The  Heat  of  an  inflamed  part  is  also  caused  by  the  unusual 
quantity  of  red  blood  present,  and  also  by  an  increase  of  that 
vital  action  upon  which  the  evolution  of  heat  depends,  namely, 
superoxidation  of  the  affected  tissues,  resulting  in  their  de- 
composition. The  increase  of  temperature  is  generally  more 
sensible  to  the  sufferer  than  to  the  observer,  though  it  may 
often  be  detected  by  the  hand,  and  is  very  evident  by  the 
clinical  use  of  the  thermometer ;  it  is  also  verified  by  compari- 
son with  other  unaffected  parts. 

The  Swelling  of  an  inflamed  tissue  is  c  aused  in  part  by  the 
unusual  quantity  of  blood  present  in  the  dilated  vessels,  and 
also  by  the  matters,  both  liquid  and  solid,  which  exude  into 
the  affected  tissue  through  the  walls  of  the  dilated  vessels,  and 
also  to  extravasation  resulting  from  rupture  of  these  walls  ;  for 
as  the  vessels  are  distended  their  walls  become  thinner,  and 
permit  the  blood  plasma  to  escape  through  them  in  greater 
quantity  than  is  required  for  mere  nourishment;  hence  the 
inflamed  tissue  becomes  infiltrated  with  this  plasma,  the  con- 
sequence of  which  is  an  increase  of  thickness  or  swelling. 
The  swelling  of  a  part,  however,  without  other  symptoms  is 
not  an  evidence  of  inflammation,  as  this  phenomenon  may 
occur  from  other  causes.  Swelling  may  also  be  absent  when 
the  other  symptoms  of  inflammation  are  present,  an  example 
of  which  is  afforded  in  inflammation  of  mucous  membranes, 
before  exudation  has  occurred  in  the  connective  tissue  be- 
neath. 

The  Pain  of  inflammation  is  due  to  the  local  irritation  of 
the  nerves  of  the'  part,  caused  by  the  irritant  which  has  excited 
the  condition ;  also  by  the  tension  which  results,  together 
with  the  injury  inflicted  upon  the  nervous  filaments.  Every 
tissue  is  supplied  with  sensory  nerves,  and  the  pain  resulting 
from  irritation  and  injury  varies  considerably,  in  accordance 
with  the  nature  of  the  part  and  its  supply  of  nervous  filaments. 
Parts  having  little  sensibility  in  a  normal  condition,  often 
become  extremely  painful  when  inflamed  ;  the  gums  afford  a 
well  marked  example.  When  the  parts  are  unyielding,  as  in 
periodontitis,  the  pain   becomes  very  severe ;    and  a  pulsa- 


INFLAMMATION.  23 


tile  or  throbbing  pain  is  caused  by  the  increased  force  of  the 
smaller  vessels  conveying  the  blood  to  the  focus  of  inflamma- 
tion, and  also  the  obstruction  of  the  circulation  produced 
by  the  swelling  and  increased  by  the  stasis  at  the  focus  of  the 
affected  area.  When  the  veins  of  an  inflamed  part  become 
obstructed  by  the  swelling,  bringing  about  pressure  to  such  a 
degree  as  to  prevent  the  blood  from  passing  through  them, 
the  quantity  being  constantly  increased  by  the  supply  from  the 
arteries,  a  condition  of  strangulation  results,  in  which  the 
pain  is  very  severe. 

We  find  an  example  of  this  condition  of  strangulation  in 
pulpitis,  or  inflammation  of  the  pulps  of  the  teeth.  Pain  is  also 
generally  present,  even  in  the  case  of  soft  tissues  affected  with 
inflammation,  and  where  every  advantage  is  afforded  for  their 
swelling ;  the  oral  mucous  membrane  is  an  example.  There  is 
also  pain  of  an  itching  character  in  certain  forms  of  inflammation 
of  mucous  membranes  ;  also  boring  pain  in  the  neighborhood  of 
joints.  The  pain  of  alveolar  abscesses,  when  they  slowly  form, 
is  often  of  a  tensive  character,  and  generally  becomes  lanci- 
nating when  they  are  about  to  point ;  and  in  all  such  cases  is 
useful  in  determining  the  seat  of  the  suppurative  process. 

Fever  of  Inflantmatioti,  also  known  as  "  traumatic,"  is  very 
generally  present  when  the  inflammation  is  severe,  or  the 
injury  occasioning  it  is  extensive  and  complicated.  This 
inflammatory  fever  generally  makes  its  appearance  in  from 
twelve  to  twenty-four  hours  after  the  injury  is  received,  or 
when  the  inflammatory  process  is  at  its  height;  and  when  the 
parts  have  previously  been  healthy,  and  the  inflammation 
limited,  it  is  moderate  in  its  character  and  soon  terminates 
spontaneously.  The  symptoms  of  inflammatory  fever  are  a 
feeling  of  fatigue,  restlessness,  thirst,  hot  and  dry  mouth, 
coated  tongue,  urine  scanty  but  deeper  in  color,  frequent  pulse, 
temperature  about  ioo°  F. ;  and  the  fever  usually  reaches 
its  climax  in  about  thirty-six  hours,  when  it  begins  to  decline, 
and  by  the  sixth  or  seventh  day  has  disappeared.  In  the  case 
of  an  abscess,  it  frequently  happens  that  when  suppuration 
occurs  the  fever  begins  to  decline.     Should  the  fever  continue 


24  DENTAL   MEDICINE. 


longer  than  the  time  referred  to,  the  cause  may  generally  be 
due  to  deeper,  suppuration  and  other  complications  of  the 
local  affection.  During  the  inflammatory  process,  when  putres- 
cent matter  has  been  absorbed  by  the  blood  in  greater  quantity 
than  can  be  resisted  or  gotten  rid  of  by  the  organism,  and 
there  is  no  escape  for  it  by  drainage,  the  symptoms  of  inflam- 
matory fever  become  more  intense,  and  a  condition  of  septic 
poisoning  takes  place,  known  as  septicczmia.  When  some  time 
has  elapsed  after  the  inception  of  the  inflammatory  process* 
and  the  characteristic  fever  has  almost  disappeared,  a  chill 
suddenly  occurs,  followed  by  profuse  perspiration,  the  condition 
known  as  py<2niia  is  present — pus  globules  in  the  blood. 

Exudation. — The  exudation  of  materials,  such  as  a  phos- 
phatic,  saline  fluid,  and  white  blood  corpuscles  and  fibrin» 
through  the  capillary  vessels,  is  due  to  inflammation,  and  such 
exudations  are  derived  from  the  blood.  The  symptom  of 
swelling  is  in  great  part  due  to  exudation.  The  exudation  in 
what  is  termed  "  healthy  inflammation,"  and  known  as  plastic 
or  coagidable  lymph,  seen  on  the  surface  of  a  recent  wound  or 
in  the  form  of  swelling  around  a  centre  of  inflammation,  is  a 
mild  and  unirritating  product,  the  function  of  which  is  to  form 
new  tissues  for  repair,  called  at  first  granulations.  Inflam- 
matory exudations  from  free  surfaces  of  mucous  membranes 
contain  mucus,  and  a  substance  known  as  mucin,  in  the  form 
of  filaments,  insoluble  in  acetic  acid.  The  inflammatory  effu- 
sion known  as  plastic  or  coagulable  lymph,  the  true  indicator  of 
a  healthy  constructive  process,  is  soon  converted  from  a  jelly- 
like substance,  by  the  germinal  power,  into  a  mass  of  living 
cells,  through  which  other  minute  cells,  which  are  to  form  the 
capillaries,  make  their  way  like  a  small  stream,  the  primitive 
living  cells  flattening  out  and  making  walls,  apparently,  for  the 
forming  vessels.  These  new  capillaries  penetrate  the  mass  of 
germinal  cells  in  large  numbers,  like  delicate  connecting 
threads,  and  furnish  the  blood  supply  to  the  organizing  mass, 
which  becomes  converted  into  new  or  young  connective  tissue. 
This  tissue  drawing  and  binding  together  the  opposite  sides  of 
the  wound,  then  becomes  the  cicatricial  tissue ,  which  originates 


INFLAMMATION.  25 


from  the  cement-like  material  furnished  by  the  inflammatory- 
exudation.  The  cicatricial  tissue  becomes  invested,  in  the 
case  of  oral  mucous  membrane,  with  epithelium,  by  a  similar 
process  of  cell  growth  and  development ;  and  this  is  the  pro- 
cess of  union  by  the  first  intention.  The  cicatrix  or  scar  is 
redder  than  natural,  owing  to  the  large  number  of  vessels ; 
but  when  the  supply  of  blood  is  no  longer  needed  in  such 
quantity  as  is  at  first  necessary,  the  capillaries  diminish  and 
disappear,  so  that  the  cicatrix  grows  paler  and  of  smaller  bulk. 
In  the  case  of  an  abrasion  of  the  skin,  the  exuding  plastic 
lymph  dries  upon  the  denuded  surface  when  not  disturbed, 
and  forms  a  protecting  crust,  which  at  length  falls  off,  exposing 
a  reddish  surface  covered  with  epidermis.  In  the  case  of  the 
oral  mucous  membrane,  a  like  result  is  produced  under  the 
protection  of  the  mucous  secretions  peculiar  to  such  a  tissue. 

Suppuration, — The  formation  of  pus  is  a  result  of  destructive 
inflammation,  as  the  presence  of  such  a  fluid  denotes  a  loss  of 
substance,  which  does  not  occur  when  a  wound  heals  by  the 
first  intention.  Under  favorable  circumstances  an  inflamed 
surface  heals  by  the  process  ol  tJie  second  intention,  as  follows: 
A  soft,  red  surface  of  coagulable  lymph  becomes  organized 
into  embryonic  tissue,  which  is  known  as  granulation  tissue, 
and  the  yellowish  fluid,  bland  in  nature,  which  is  present  is 
pus ;  these  materials  or  "  products  of  inflammation  "  being 
generated  for  reparative  processes.  The  granulation  tissue  is 
composed  of  embryonic  cells  and  a  network  of  capillary  loops, 
by  which  the  tissue  receives  its  supply  of  nutritive  matter 
from  the  blood,  so  that  it  may  become  what  is  recognized 
later  as  the  cicatricial  tissue,  or  one  of  a  higher  organism  than 
the  granulation  tissue.  The  granulation  tissue  is  of  a  variable 
pinkish  color,  the  tint  depending  upon  the  quality  of  the  blood 
which  its  vessels  contain,  and  is  of  a  jelly-like  consistence, 
and  somewhat  smooth  and  firm.  Its  surface,  when  in  a  normal 
condition,  is  studded  over  with  small  conical  prominences 
called  granulations,  in  which  are  very  minute  vessels  situated 
so  superficially  as  to  bleed  on  the  slightest  touch. 

Pus  of  a  yellow  color  is  found  between  the  granulations, 


26  DENTAL   MEDICINE. 


which  vary  in  size,  form  and  color,  a  moderate  bright-red 
color  being  indicative  of  a  healthy  healing  process. 

When  there  is  a  want  of  power  in  the  process  of  forming 
the  cicatricial  or  repair  tissue,  the  granulations  become  large 
and  translucent,  and  the  pus  which  surrounds  them  is  pale  and 
thin.  If  the  affected  surface  is  exposed  to  friction,  or  irritation 
from  other  causes,  the  granulations  become  extremely  small 
and  of  a  deeper  red  color  than  is  normal,  and  at  length  may 
disappear  at  points,  leaving  grayish  spots  or  smooth  patches. 
If  the  process  of  cicatrization  is  prevented  in  its  first  stage,  the 
granulations  become  large  and  coalesce,  protruding  and  over- 
hanging the  edges  of  the  wound,  and  forming  what  is  com- 
monly known  as  "  proud  flesh."  During  the  entire  healing 
process  a  flow  of  pus  is  going  on  from  the  affected  surface  as 
a  normal  act,  and  the  first  appearance  of  it  is  indicative  of 
repair.  Its  appearance  is  also  coincident  with  the  organization 
of  plastic  lymph.  When  the  suppuration  is  well  established, 
the  heat,  tension  and  swelling  of  the  inflamed  part  become  less 
in  degree,  and  the  frequency  of  the  pulse  and  the  temperature 
of  the  body  diminish.  Whenever  the  granulating  surface  is 
formed,  union  by  the  second  iJttention,  or  second  adhesion,  as  it 
is  termed,  will  take  place,  if  separated  surfaces  are  brought 
into  apposition. 

Origin  and  Characteristics  of  Pus. — Pus  is  a  secretion  fur- 
nished by  the  blood  at  the  expense  of  the  tissues,  an  exuberant 
quantity  of  plastic  material,  for  which  excess  there  is  no 
demand  in  the  reparative  process.  The  leucocytes  which  are 
brought  to  the  surface  of  a  granulating  wound  are  discharged 
from  it  in  the  form  of  pus,  while  those  that  remain  behind 
develop  into  tissue.  This  effect,  by  which  the  excess  of  leu- 
cocytes is  gotten  rid  of,  is  accomplished  by  liquid  exudation, 
the  supply  of  which  comes  from  the  newly  formed  and  the  old 
capillaries,  and  is  the  same  force  that  carries  the  nutritive 
material  to  the  tissues.  Healthy  pus  is  of  a  yellowish-white 
color,  sometimes  assuming  a  pale  greenish  tint,  of  cream-like 
consistence ;  a  slightly  saltish  taste,  but  somewhat  sweet ;  a 
faint  animal  odor,  with  an  alkaline  reaction.     The  presence  of 


INFLAMMATION.  27 


bile  may  give  to  pus  a  deep  orange  color,  while  all  of  the 
other  shades  are  due  to  the  coloring  matter  of  the  blood, 
known  as  hsematoidine.  As  long  as  the  air  has  access  to  it, 
there  is  little  tendency  to  putrefaction ;  and  even  when  it  is 
removed  from  the  body  and  exposed  to  ordinary  temperature, 
change  in  it  occurs  very  slowly.  Pus  consists  of  two  portions 
— a  solid  portion  known  as  pus  corpuscles,  and  which  consists 
almost  entirely  of  young  pus  cells  or  leucocytes,  and  a  liquid 
portion  known  as  liquor  puris,  which  is  a  serous  fluid,  and  con- 
stitutes about  three-fourths  of  its  bulk. 

When  pus  is  subjected  to  pressure,  as  sometimes  occurs  in 
abscess  of  the  antrum,  and  about  bones,  it  may  become  a  yel- 
lowish, cheesy  mass,  owing  to  the  compression  of  the  pus 
cells.  The  solid  portion  of  pus  consists  of  more  than  nine- 
tenths  of  leucocytes  or  young  pus  cells,  which,  in  freshly 
formed  pus,  presents  under  the  microscope  a  granular  appear- 
ance, and  also  the  peculiar  movements  of  active,  young  and 
healthy  leucocytes ;  but  pus  which  has  collected  in  an  abscess 
for  several  days  shows  no  such  movements,  thereby  indicating 
that  the  leucocytes  have  died.  Living  and  dead  pus  cells  may 
be  found  in  ordinary  pus,  mingled  together.  Pus  also  contains 
such  micro-organisms  as  vibrios  and  bacteria. 

Varieties  of  Pus. — The  constitution  of  pus,  which  is  subject 
to  constant  change,  depends  upon  the  form  of  the  disease,  the 
locality,  and  the  condition  of  the  patient.  When  it  is  of  a 
yellowish-white  color,  of  the  consistence  of  cream,  and  com- 
posed of  a  great  number  of  pus  globules,  it  is  called  "  healthy," 
"  pure,"  or  "  laudable."  "  Sanioics,"  "  serous,"  and  "  ichorous" 
pus  is  almost  transparent,  of  a  yellowish,  oily,  or,  reddish 
color,  and  very  acrid,  being  the  product  of  unhealthy  inflam- 
mation, and  is  common  to  caries  of  the  bones,  irritable  ulcers, 
etc.,  and  frequently  mixed  with  blood,  particles  of  fibrin,  and 
dead  tissue.  In  chronic  and  cold  abscesses  the  pus  corpuscles 
become  pale  and  watery,  showing  that  they  are  undergoing 
solution  ;  the  pus  from  epithelial  tumors,  indolent  ulcers,  and 
phagedenic  ulcers,  is  thin  and  sanious,  and  contains  more  or 
less  dead  tissue,  which  prevents  the  repair. 


28  DENTAL   MEDICINE. 


The  term  abscess  denotes  a  collection  of  pus  in  the  substance 
of  the  tissues,  and  the  formation  of  the  acute  form  is  as  follows  : 
The  exciting  cause,  acting  as  an  irritant,  causes  an  afflux  of 
blood  to  the  centre  of  the  affection,  and  the  distended  capilla- 
ries pour  out  liquid  exudation,  which  coagulates  at  this  centre 
into  plastic  lymph,  expanding  the  meshes  of  the  neighboring 
surrounding  tissues  with  a  more  serous  fluid. 

Leucocytes  are  formed  from  cell  proliferation  in  the  plastic 
lymph,  but,  on  account  of  their  not  being  in  a  proper  place 
for  their  growth  and  development  into  tissue,  they  become 
changed  into  pus,  which  collects  in  a  cavity  formed  by  it,  and 
the  result  is  an  abscess.  As  these  phenomena  occur  in  rather 
quick  succession,  pain,  heat,  redness  and  swelling  are  present, 
and  also  constitutional  disturbance  in  the  form  of  hectic  fever. 

The  increase  of  an  abscess  in  size  is  attended  with  a  certain 
amount  of  redness  on  the  surface  over  it  and  to  which  it  is 
approaching,  this  increasing  redness  being  preceded  by  more 
or  less  oedema  of  the  tissue  beneath,  which  is  owing  to  the 
protruding  of  the  serous  exudation  surrounding  the  central 
collection  of  pus.  The  centre  of  the  surface  redness  then 
presents  a  more  prominent  and  elevated  point,  where  the  outer 
tissue  becomes  thinner,  purplish,  or  livid,  and  soon  the  yellow 
pus  within  is  visible  through  it — a  condition  to  which  the 
t^rm  pointing  is  applied.  Soon  after  the  "  pointing,"  the  in- 
tegument gives  way  and  the  pus  exudes  through  the  opening 
thus  made. 

This  thinning  and  weakening  of  the  surface  is  caused  by 
the  stretching  and  obstruction  of  the  blood  vessels,  which 
convey  the  nutritive  supply  from  beneath,  by  the  pressure  of 
the  enlarging  abscess  to  such  a  degree  that  the  surface  integu- 
ment is  deprived  of  its  blood  and  slowly  dies  by  minute  par- 
ticles, the  dead  material  being  added  to  the  contents  of  the 
abscess. 

An  abscess  unattended  with  such  symptoms  as  pain,  heat, 
and  redness,  is  termed  a  cold  abscess,  and  its  presence  depends 
upon  a  low  degree  of  vitality. 

A  cold  abscess  presents  the  same  phenomena  of  pus  forma- 


INFLAMMATION.  29 


tion  as  the  acute  form,  but  resembles  more  the  growth  of  a 
tumor,  as  all  the  symptoms  may  be  absent  except  the  swelling. 
The  formation  of  pus  on  the  surface  of  a  tissue,  such  as  mu- 
cous membrane,  is  not  so  serious  as  that  in  an  abscess,  as  the 
conversion  of  the  leucocytes  into  pus  requires  but  little  more 
increased  activity  than  in  cell  germination.  The  exudation 
takes  place  from  the  network  of  capillaries  which  exist  beneath 
every  mucous  membrane,  and  which  furnishes  nourishment 
for  the  constant  renewal  of  the  epithelium,  and  any  injury 
received  causes  a  fluxion  of  blood  to  the  capillaries,  which 
increases  the  cell  proliferation.  The  effect  is,  then,  to  promote 
an  increased  discharge  from  the  surface  of  the  membrane,  in 
the  form  of  pus.  Suppuration  from  mucous  membrane  usu- 
ally causes  pain,  heat,  increased  redness,  and  swelling  of  the 
inflamed  surface,  owing  to  the  exudation  into  the  meshes  of 
the  connective  tissue  beneath,  and  recovery  is  characterized 
by  diminished  fluxion  of  blood  to  the  affected  part,  and  conse- 
quent lessening  of  cell  production  ;  the  cells  resume  their  func- 
tion of  producing  epithelial  tissue,  the  pus  becomes  thin  and 
more  fluid,  and  finally  ceases  when  the  normal  conditions  again 
appear. 

Hectic  fever  is  a  symptom  of  destructive  inflammation,  and 
is  a  persistent,  low  form  of  continued  fever,  characterized  by 
remission  and  exacerbation  morning  and  night.  This  form  of 
fever  is  caused  by  absorption  into  the  blood  of  some  of  the 
products  of  inflammation,  in  such  quantities  and  so  gradually 
as  not  to  produce  an  immediate  fatal  result,  and  inducing  a 
regular  succession  of  chill,  fever,  and  perspiration  during  the 
space  of  every  twenty-four  hours.  Its  effect  is  progressive 
emaciation  and  a  tendency  to  fatal  termination,  if  the  cause  is 
not  removed,  through  combustion  of  tissue  material  to  supply 
the  fever  heat.  The  regularity  of  the  night  sweats,  and  the 
pulse  retaining  its  frequency  during  the  apyrexia,  even  in  the 
morning,  when  the  temperature  is  normal,  are  the  diagnostic 
signs  of  hectic  from  typhoid  and  malarial  fevers. 

The  most  unfavorable  symptoms  of  hectic  fever  are  the 
higher  fever  in  the  evening,  the  increase  in  the  frequency  of 


30  DENTAL   MEDICINE. 


the  pulse,  the  more  exhausting  night  sweats,  with  the  occur- 
rence of  aphthae  in  the  mouth,  and  diarrhoea. 

Chronic  Inflammation. — Chronic  or  asthenic  inflamma- 
tion is  a  process  in  which  all  the  cardinal  symptoms  of  inflam- 
mation may  be  present,  but  in  less  degree  than  in  the  acute 
form.  In  chronic  inflammation  there  is  present  a  permanent 
local  hyperaemia,  attended  with  an  exudation  into  the  inter- 
stices of  the  inflamed  part,  or  from  its  surface.  The  pain  in 
this  form  is  usually  slight,  or  may  be  intermittent,  or  even 
absent,  or  be  no  more  than  an  itching  sensation ;  heat  is 
present,  but  is  not  a  prominent  symptom ;  the  redness  is  of  a 
light  hue,  sometimes  livid,  from  passive  hyperaemia  and  the 
stretching  of  the  vessels  by  the  over  distention  to  which  they 
had  before  been  subjected,  and  the  diminished  force  of  the 
circulation;  the  swelling  is  in  the  form  of  induration,  owing  to 
the  exudation  having  become  organized  into  tissue.  This 
latter  accounts  for  the  hardness  around  an  indolent  ulcer,  and 
an  old  sinus.  Inflammatory  induration  consists  of  the  new 
tissue  growth  in  the  state  of  more  imperfect  organization  than 
the  normal  cicatricial  tissue.  In  mucous  membranes  indura- 
tion is  indicative  of  chronic  inflammation,  and  is  caused  by 
exudative  infiltration  into  the  substance  of  the  submucous  con- 
nective tissue,  and  a  considerable  change  of  structure  in  these 
membranes  often  occurs.  Although  the  symptoms  of  chronic 
inflammation  are  present  in  a  limited  degree,  yet  they  are  more 
persistent,  on  account  of  the  object  for  which' the  increased 
nutritive  effort  was  made  proving  unsuccessful. 

Ulceration  is  a  passive  process,  and  results  from  the 
molecular  death  caused  by  insufficient  blood  supply,  insuffi- 
cient nervous  influence,  impure  quality  of  blood,  or  the 
presence  of  blood  poison.  Ulceration  is  very  closely  associ- 
ated with  inflammation,  although  the  former  may  be  independ- 
ent of  the  latter,  and  consists  of  a  progressive  softening  and 
disintegration  of  successive  layers  of  the  affected  tissue. 
Ulceration  generally  begins  in  a  process  of  chronic  inflamma- 
tion, and  in  such  a  manner  that  the  death  of  the  tissues  only 
occurs  when  the  tissues  themselves  have  undergone  cellular 


INFLAMMATION.  31 


infiltration  in  consequence  of  the  inflammatory  changes.  The 
loss  of  the  integument  leaves  a  red,  raw  surface,  which  bleeds 
easily,  and  which  is  covered  with  a  tenacious,  slimy  matter. 
Very  soon  irregular  cavities  are  formed  in  this  surface,  sepa- 
rated by  red  elevations  with  ragged  edges.  A  thin,  serous, 
bloody  discharge  exudes,  with  severe  pain  of  a  gnawing  char- 
acter. The.  ulcer  then  formed,  and  which  has  been  defined  as 
"  a  wound  surface  having  no  tendency  to  heal,"  spreads  more 
or  less  rapidly,  and  the  surrounding  integument  is  hot  and 
swollen,  and  the  disintegrated  tissue  is  thrown  off  as  extraneous 
matter.  Ulcers  also  originate  from  pustules  that  fail  to  heal 
after  the  pus  escapes,  but  spread  and  maintain  an  acute  inflam- 
matory character.  An  ulcer  may  be  circular,  crescentic, 
irregular,  in  the  form  of  a  shallow  or  deep  ring,  or  it  may  be 
tubular,  forming  a  fistula. 

The  edges  of  an  ulcer  are  either  low  or  raised,  hard  (callous), 
soft,  jagged,  vertical,  everted,  or  undermined,  etc.  Ulcers 
arising  from  persistent  local  irritation,  as  those  of  the  oral 
mucous  membrane,  usually  heal  as  soon  as  the  affected  parts 
are  placed  under  favorable  external  circumstances.  As  long 
as  the  epithelium  is  preserved,  the  superficial  inflammatory 
process  in  mucous  membranes  may  be  called  catarrh.  When 
suppuration  of  mucous  membranes  proceeds  so  far  as  to  expose 
the  sicbstantia  propria  or  corium,  the  diseased  surface  is  known 
as  an  ulcer. 

Effects  of  Micro- Orgajiisms. — While  some  of  the  common 
parasites  cause  injurious  effects  by  inciting  inflammation  in 
tissues  and  organs,  they  only  act  as  foreign  bodies,  while  the 
microscopic  fungi  and  their  germs,  acting  as  invisible  particles 
of  organized  matter,  cause  the  greatest  injury.  If  they  are 
protected  from  the  influence  of  oxygen,  these  micro-organisms 
germinate  very  rapidly,  and  derive  their  sustenance  from  the 
fluids  of  the  inflamed  tissue  and  the  granulating  surface.  The 
form  known  as  vibrio  septica  generate  putrefaction  in  animal 
matter  by  bringing  about  a  process  of  fermentation — dental 
caries  affords  an  example.  The  chemico-vital  changes  accom- 
panying   the  process    of  putrefactive    fermentation  give  rise 


32  DENTAL   MEDICINE. 

to  septic  poisons^  which,  being  absorbed  in  the  circulation, 
result  in  septiccBinia  and  pycBinia.  Dr.  Koch  affirms  that 
"  bacteria  do  not  occur  in  the  blood  nor  in  the  tissues  of  the 
healthy  living  body,  either  of  man  or  of  the  lower  animals," 
and  the  same  investigator  also  says :  "  When  introduced  by 
inoculation  into  animal  tissues,  they  multiply  and  excrete 
soluble  substances,  which  get  into  the  surrounding  tissues  by 
diffusion." 

The  tissues,  by  the  contact  of  the  micrococci,  lose  their 
vitality,  and  the  parasite  growth  multiplies  and  spreads  rapidly 
in  the  dead  tissues,  advancing  directly  toward  the  parts  in 
which  vitality  yet  remains. 

Terminations  of  Inflammation. — According  to  the  present 
knowledge  of  this  subject,  inflammation  terminates — ist,  By 
Resolution  ;  2d,  By  Formatioii  of  New  Tissue ;  3d,  By  Gan- 
grene, or  Local  Death — Necrosis.  When  the  inflammatory 
process  terminates  by  resolution,  all  of  the  symptoms  gradually 
diminish  and  disappear,  and  the  affected  tissues  resume  their 
normal  condition.  Such  a  result  is  generally  due  to  the  mild 
character  of  the  injury,  and  the  progress  of  the  inflammation. 

When  the  inflammatory  process  terminates  by  the  formation 
of  new  tissue,  the  new  growth  is  produced  by  inflammation — 
either  by  the  union  by  first  intention,  or  by  the  development 
of  granulations,  which  become  organized  into  a  cicatrix. 

When  the  inflammatory  process  terminates  m  gangrene,  or 
local  death,  the  effort  of  the  inflammation  toward  repair  has 
failed,  either  on  account  of  the  functions  of  the  capillaries  and 
the  connective  tissue  becoming  impeded  to  such  a  degree  as  to 
render  inoperative  the  resources  of  the  organisms,  or  because 
of  certain  conditions  arising  at  a  later  period  which  have 
obstructed  the  reparative  effort  and  caused  the  parts  to  lose 
their  vitality. 

The  termination  of  the  inflammatory  process  by  gangrene 
depends  upon  the  degree  and  nature  of  the  lesion,  and  the 
inability  of  the  capillaries  and  arteries  to  maintain  the  local 
circulation.  The  impairment  of  the  vitality  of  the  blood 
vessels  causes  stasis  and  thrombosis  to  occur,  and  as  soon  as 


INFLAMMATION.  33 


actual  death  takes  place,  the  dead  tissue  presents  a  further 
obstacle  to  the  local  circulation,  and  also  adds  to  the  difficulty 
of  elimination,  which  favors  the  spread  of  the  gangrene.  The 
earliest  symptoms  of  gangrene  are  hard  swelling,  burning  and 
tensive  pain,  and  livid  color.  The  pain  then  subsides,  vesica- 
tions appear,  the  part  takes  on  a  marbled,  purplish-yellow 
color,  afterward  becoming  brown  or  grayish,  and  finally  cold 
and  insensible,  exhaling  a  putrid  odor. 

Treatment  of  Inflammation. — It  has  already  been  stated 
that  the  causes  of  inflammation  determine  in  a  great  measure 
its  treatment,  and  this  is  especially  true  of  inflammation  of  the 
oral  mucous  membrane.  The  indications  of  treatment  are  as 
follows : — 

Prevention  and  Removal  of  Cause. — Prevention  may  include 
the  removal  of  a  predisposing  cause  when  local,  or  the  lessen- 
ing of  its  effects  when  it  is  general  or  constitutional.  If 
malaria  is  present,  quinine  is  indicated ;  if  syphilis,  iodide  of 
potassium,  or  minute  doses  of  bichloride  of  mercury. 

Irritation,  the  precursor  of  inflammation,  may  often  be 
arrested  by  the  removal  of  a  local  cause,  such  as  salivary  calcu- 
lus, for  example.  The  restoration  of  the  secretion  of  the 
different  organs  is  also  indicated  in  the  treatment  of  certain 
forms  of  inflammation,  and  also  the  use  of  such  palliative 
remedies  as  will  allay  the  excitement  of  the  nervous  system. 
When  the  cause  is  apparent,  its  removal  is,  as  a  general  rule, 
easily  accomplished ;  but  when  the  cause  is  obscure,  the  con- 
dition of  the  secretions  of  the  bowels  and  the  diet  should 
receive  careful  attention.  To  correct  the  secretions,  purgatives 
are  indispensable  ;  also  such  other  depletory  measures  as 
bleeding,  abstinence  from  food,  use  of  emetics  or  nauseants  to 
lessen  the  general  circulation  and  reduce  the  vascular  tension. 
To  allay  the  nervous  excitement  and  irritability,  narcotics  or 
opiates  are  indicated,  their  direct  effect  being  relief  of  pain  and 
spasm,  and  inducement  to  rest  and  tranquillity. 

The  advantage  of  rest  and  immobility  cannot  be  over  esti- 
mated, for  a  simple  lesion,  if  subjected  to  constant  mobility, 
may  become  one  of  a  much  greater  character,  destructive 
3 


34  DENTAL   MEDICINE. 


inflammation  often  being  provoked  by  friction  and  undue 
motion.  An  qxamxple  is  furnished  in  the  case  of  periodon- 
titis, where  a  cap  or  partial  interdental  splint  made  of  model- 
ing composition  or  gutta  percha,  or  vulcanized  rubber,  will 
protect  the  affected  tooth  from  irritation,  and  materially  assist 
the  remedial  measures ;  also  strips  of  adhesive  plaster,  collo- 
dion, etc.,  will  insure  immobility  in  certain  cases  where  such 
appliances  are  indicated,  as  undue  motion  retards  and  prevents 
the  process  of  healing. 

Position  is  also  to  be  considered  as  a  means  for  relieving 
the  irritation  and  pain,  so  that  no  provocation  may  exist  for 
subsequent  inflammation.  The  best  position  should  be  selected 
for  the  affected  part,  which  will  favor  the  return  of  venous 
blood  and  retard  the  arterial  current;  hence,  an  elevated 
position  will  tend  to  prevent  passive  hyperaemia.  A  favorable 
position  will  also  secure  muscular  relaxation,  and  prevent  the 
involuntary  spasmodic  action,  which  may  result  from  muscular 
tension.  The  administration  of  an  anaesthetic  to  secure  mus- 
cular relaxation,  in  the  case  of  certain  injuries,  as  in  fracture 
or  dislocation  of  the  jaw,  is  often  resorted  to  as  a  measure 
against  spasmodic  contraction,  and  also  to  reduce  the  excessive 
vascular  reaction. 

Cold,  when  outwardly  applied  as  a  depressor  to  the  inflamed 
part,  reduces  the  excitement  and  irritability.  The  application 
of  the  spray  of  absolute  ether,  or  of  rhigolene,  will  often 
prove  serviceable  in  the  early  stage  of  periodontitis.  Cold, 
whenever  moderately  applied,  is  tonic  and  invigorating,  and 
besides  evaporating  applications,  ice  may  be  employed ;  but 
such  local  measures  to  maintain  a  low  temperature  must  be  re- 
newed at  short  intervals.  Cold,  when  locally  applied,  causes 
the  capillaries  to  contract,  thus  diminishing  the  afflux  of  blood 
to  the  affected  tissue.  The  persistent  application  of  cold,  how- 
ever, may  cause  gangrene;  but  the  employment  of  the  ether  or 
rhigolene  spray  is  attended  with  less  danger  in  this  respect 
than  that  of  ice  applications,  A  granulating  surface,  on  the 
other  hand,  develops  better  in  a  warm  temperature. 

Heat  and  Moisture, — Heat  is  also,  under  certain  circum- 


INFLAMMATION.  35 


stances,  a  valuable  antiphlogistic.  Dry  heat  will  mitigate  pain, 
and  heat  with  moisture,  in  the  form  of  a  poultice,  is  very  com- 
monly used  to  relieve  the  pain  and  tensive  heat  of  local  in- 
flammation by  its  soothing  and  relaxing  effect.  While  cold 
has  an  astringent,  sedative  effect,  and  constringes  the  capilla- 
ries of  the  inflamed  tissue,  thus  promoting  healing  by  resolu- 
tion, moist  heat  is  relaxing  and  promotes  exudation,  if  not 
suppuration,  leading  to  repair  by  "  the  second  intention."  The 
use  of  cold  is  dispensed  with  in  inflammatory  conditions  as 
soon  as  it  is  apparent  that  the  termination  of  the  inflammation 
by  resolution  is  impossible,  when  resort  is  had  to  poultices  or 
warm  fomentations,  such  as  flaxseed  and  slippery-elm  bark, 
to  which  vaseline,  boracic  acid,  or  a  weak  solution  of 
carbolic  acid  may  be  added,  to  prevent  fermentation  in  the 
poultice,  and  putrefaction  in  the  wound.  To  relieve  pain^ 
tincture  of  opium  may  be  applied  to  the  surface  of  the  poultice, 
a  water  dressing,  composed  of  cloth  saturated  with  warm 
water  or  a  medicated  solution,  such  as  boracic  acid  or  biborate 
of  sodium.  The  local  warm  bath  is  also  another  method  of 
applying  heat  and  moisture,  as  the  granulations  of  a  surface 
immersed  in  tepid  water  develop  favorably  ;  and  an  ulcerated 
surface  which  has  been  subjected  to  a  prolonged  warm  bath, 
made  antiseptic  by  carbolic  acid,  or  the  application  of  an  eight 
per  cent,  solution  of  chloride  of  zinc,  is  greatly  benefited. 
Warmth  and  moisture  are  especially  indicated  for  parts  having 
a  feeble  circulation.  Warm,  moist  applications,  such  as  poul- 
tices, promote  the  tendency  to  suppuration  ;  hence,  care  should 
be  observed  in  applying  such  applications  to  the  surface  of  the 
face,  in  the  case  of  an  alveolar  abscess,  as  pointing  and  the 
escape  of  pus  may  be  induced  in  a  position  where  permanent 
disfigurement  would  be  very  apparent. 

CojHpression  is  also  of  service  in  the  treatment  of  certain 
forms  of  inflammation,  especially  during  the  late  stages,  but 
it  must  be  uniformly,  moderately,  and  continuously  applied. 
Even  in  the  acute  form,  compression  may  prevent  the  over-dis- 
tention  of  the  capillaries  and  limit  the  exudation  ;  in  the  chronic 
form,  compression  promotes  absorption.     It  is  accomplished  by 


36  DENTAL   MEDICINE. 


means  of  bandages,  either  alone  or  in  conjunction  with  cotton 
batting,  as  the  latter  prevents  irregular  constriction  and  main- 
tains a  uniform  temperature.  A  fine  compressed  sponge, 
moistened,  after  it  is  applied,  with  tepid  water,  is  a  .painless  and 
effective  means  for  obtaining  compression  in  the  treatment  of 
indolent  ulcers.  Compression  by  means  of  sheet  lead  or  tin, 
and  pads  of  bibulous  paper,  will  often  prevent  an  alveolar 
abscess  from  discharging  on  the  surface  of  the  cheek  or  neck, 
when  such  an  event  is  imminent. 

Bloodletting. — General  bloodletting  is  now  rarely  employed 
in  the  treatment  of  inflammation ;  but  the  local  abstraction  of 
blood  by  means  of  leeches,  cups,  scarification,  incisions,  and 
other  means,  is  of  great  service  in  reducing  vascular  action, 
and  lessening  inflammatory  symptoms.  The  efficiency  of  local 
depletion  in  relieving  hyperaemia  is  very  evident  by  the  cessa- 
tion of  pain  caused  by  strangulation  and  tension.  Periodon- 
titis and  acute  gingivitis  furnish  examples.  Leeches  should 
never  be  applied  to  a  part  where  it  would  be  difficult  to 
arrest  the  hemorrhage  which  may  follow  their  use ;  their 
application  is  also  contraindicated  in  the  case  of  children,  who 
cannot  bear  the  loss  of  considerable  blood  with  impunity. 

Incisions  are  made  for  the  purpose  of  relieving  tension  and 
pain,  evacuating  pus,  or  the  escape  of  dead  material,  for 
tension  aggravates  the  inflammation  and  the  retention  of 
pus  in  an  abscess  prolongs  the  pain,  and  also  adds  to  the 
destruction  of  parts  by  the  formation  of  gangrenous  patches. 
Superficial  incisions  will  relieve  the  tension  of  the  skin  and 
mucous  membrane,  and  also  evacuate  the  pus  of  an  abscess 
when  it  is  near  the  surface. 

Deeper  incisions  are  necessary  when  the  pus  is  at  a  greater 
distance  from  the  surface,  and  there  is  considerable  tension. 
Incisions  are  also  often  judicious  as  a  prevention  of  suppura- 
tion and  ulceration  ;  also  in  cases  where  the  presence  of  pus 
is  suspected,  but  there  is  no  apparent  fluctuation.  In  making 
deep  incisions,  care  is  necessary  to  avoid  wounding  arteries 
and  nerves ;  hence  the  director  should  precede  the  use  of  the 
knife.     In  acute  abscesses  the  incisions  should  be  made  at  an 


INFLAMMATION.  37 


early  stage,  and  of  such  a  size  as  will  permit  of  the  free  evacu- 
ation of  the  pus,  and  in  the  most  depending  position,  to  insure 
its  easy  discharge.  Hence,  as  soon  as  fluctuation  is  detected 
in  an  acute  .abscess,  the  incision  for  the  escape  of  the  pus 
should  be  made  ;  while  in  the  case  of  a  chronic  or  cold 
abscess,  the  incision  may  be  delayed,  or  a  puncture  with  a 
trocar  substituted  for  it,  which  may  at  once  be  closed. 

Drainage  is  employed  for  the  purpose  of  giving  outlet  for 
any  matters  liable  to  collect  in  a  wound  or  abscess  which  may 
act  as  obstacles  to  the  process  of  repair.  Teeth  affected 
with  abscess  are  often  relieved  and  retained  by  an  opening 
made  into  the  pulp  canal  or  into  the  abscess  sac,  sufficiently 
free  to  relieve  the  tension  and  drain  off  the  accumulated  pus  ; 
also  in  the  case  of  abscess  of  the  antrum,  where  an  opening 
made  through  the  alveolar  cavity  of  one  of  the  roots  of  a 
posterior  tooth  is  kept  open  by  means  of  a  canula,  to  relieve 
the  tension  and  permit  the  pus  to  escape  as  it  accumulates, 
and  also  to  afford  an  easy  entrance  for  the  injection  of  anti- 
septic and  stimulating  agents  in  the  treatment  of  such  cases. 
Drainage  can  also  be  made  through  soft  tissues,  such  as  the 
gum,  etc.,  by  strands  of  floss  silk,  hemp  thread,  and  horse 
hair,  dipped  in  a  carbolic  acid  solution  before  they  are  inserted 
into  the  opening  connected  with  the  sac;  also  by  means  of 
caoutchouc  tubing. 

Counter- Irritants,  or  ''  derivatives,"  are  also  employed  in 
the  treatment  of  inflammation,  for  the  purpose  of  inducing  an 
afflux  of  blood  from  the  locality  of  the  inflammation  to 
another  point  in  close  proximity,  thus  relieving  the  vessels  of 
the  affected  part.  Such  counter-excitement  in  the  case  of  the 
oral  mucous  membrane,  is  induced  by  blistering  applications, 
stimulants,  escharotics,  etc.,  which  excite  a  new  action  in  a 
part  more  or  less  remote  from  the  focus  of  inflammation. 

Cantharidal  collodion,  tincture  of  iodine,  either  alone  or  in 
combination  with  aconite,  or  with  creasote,  or  with  carbolic 
acid,  nitrate  of  silver,  nitric  acid,  and  the  actual  cautery,  may 
be  named  as  the  most  common  counter-irritants  for  applica- 
tion to  the  oral  mucous  membrane  in  the  case  of  deep-seated 


38  DENTAL   MEDICINE. 


inflammation  and  pulpitis ;  and  are  mainly  useful  in  the  early- 
stage  of  the  acute  form,  and  in  the  chronic  form. 

Mouth  Washes  and  Lotions,  such  as  tincture  of  myrrh, 
chlorate  of  potassa,  solutions  of  carbolic  acid,  listerine,  per- 
manganate of  potash,  nitrate  of  silver,  sulphate  of  copper, 
sulphate  of  zinc,  oxide  of  zinc,  lead  water,  tincture  of  opium, 
etc.,  are  employed  with  benefit  in  superficial  inflammations 
and  ulcerations  of  the  oral  mucous  membrane. 

When  putrefaction  is  present  in  the  inflamed  part,  chlorinous 
washes  are  serviceable  for  deodorizing  purposes,  and  also  to 
prevent  the  entrance  of  putrid  matter  into  the  circulation. 
The  object  of  cauterizing  an  inflamed  part  is  to  break  the 
continuity  of  the  morbid  process. 

Ancssthetics,  such  as  chloroform,  ether,  etc.,  when  employed 
in  the  treatment  of  inflammation,  exercise  an  influence  as 
preventives,  and  also  render  lax  tissues  which  become  very 
rigid,  and  enable  reductions  to  be  made,  as  well  as  temporarily 
mitigating  the  pain ;  fracture  and  dislocation  of  the  jaw  are 
examples. 

When  inflammation  has  devitalized  parts,  the  treatment 
varies  in  respect  to  the  nature  of  such  parts.  Dead,  soft  tissues 
are  to  be  so  treated  that  the  putrid  matter  is  prevented  from 
entering  the  circulation,  by  the  application  of  antiseptic  agents, 
which  have  in  a  great  measure  replaced  antiphlogistics  ;  hence, 
antiseptics  which  possess  the  power  of  destroying  micro- 
organisms without  the  danger  of  destroying  the  vitality  of 
the  tissues,  are  considered  to  be  the  most  active  agents  of 
this  class.  When  the  hard  tissues  are  devitalized,  such  as 
bone,  for  example,  although  the  living  bone  becomes  sepa- 
rate from  the  dead  portion  as  effectually  as  a  living  soft  part 
from  its  slough,  yet  it  is  necessary  to  liberate  the  bony  seques- 
trum from  the  overlying  texture  which  may  confine  it ;  hence 
the  removal  of  dead  bone  is  necessary  as  soon  as  the  line  of 
demarcation  is  formed,  the  time  for  which  may  vary  from  a 
period  of  less  than  three  weeks  in  the  case  of  small  sequestra, 
to  more  than  two  months,  where  the  entire  bone  is  involved. 
Also  in  cases  where  the  extremity  of  a  part  consisting  of  soft 


INFLAMMATION.  39 


and  hard  tissues,  for  example,  the  alveolar  process  and  tissues 
over  it,  become  gangrenous,  it  is  best,  in  most  instances,  to 
remove  the  dead  tissues  by  amputation  ;  and  such  an  operation 
may  also  become  necessary  in.  cases  of  long-continued  ex- 
haustive suppuration.  Many  forms  of  inflammation  have 
their  special  remedies,  such  as  mercurial  inflammation  of  the 
mouth,  when  chlorate  of  potash  is  indicated ;  periodontitis, 
when  tincture  of  iodine  and  tincture  of  aconite,  or  creasote,  or 
carbolic  acid,  in  combination  with  the  iodine,  etc.,  are  indicated ; 
gingivitis,  where  stimulating  and  antiseptic  washes  and  lotions 
of  tincture  of  myrrh,  biborate  of  soda,  carbolic  acid  solutions 
and  combinations,  etc.,  are  indicated. 

General  Remarks. — In  every  case,  the  first  object  should  be 
to  ascertain  and,  if  possible,  remove  the  cause  of  a  disease. 
It  should  be  remembered  that  medicinal  substances  are  always 
more  certain  in  their  action  when  applied  directly  to  the  afiected 
tissue;  also,  that  chemical,  physical  and  vital  changes  result 
from  the  topical  action  of  such  substances;  and  that  age 
modifies  the  effects,  and  also  determines  the  dose ;  also,  sex, 
owing  to  the  greater  susceptibility  of  the  nervous  system  in 
females  than  in  males ;  also  the  temperament,  as  the  sanguine, 
for  example,  is  more  susceptible  to  the  influence  of  medicinal 
agents  than  the  phlegmatic ;  also  habit  and  mode  of  life,  as  the 
habitual  use  of  such  agents  as  stimulants  lessens  their  influ- 
ence, and  the  occupation  affects  the  susceptibility  to  external 
influence ;  also  the  co?idition  of  the  body,  as  different  diseases 
exercise  considerable  influence  on  the  effects  of  medicinal 
substances ;  also  the  mind,  as  a  hopeful  mind  conduces  to  the 
beneficial  action  of  medicines;  also  idiosyncrasy,  2iS  some  indi- 
viduals are  more  susceptible  to  the  action  or  effects  of  medi- 
cinal substances  than  others  ;  also  the  nature  of  the  tissue  or 
organ  to  which  application  is  made,  as  some  are  more  suscep- 
tible to  the  effect  of  medicinal  agents  than  others,  owing  to 
rapidity  of  absorption  and  the  degree  of  decomposition  of  the 
substance  employed ;  also  climate,  from  the  recognized  influ- 
ence of  climate  in  modifying  the  structure  and  functions  of 
the  animal  economy,  and  increasing  or  diminishing  morbid 


40  DENTAL   MEDICINE. 


conditions,  and  by  such  means  influencing  the  effects  of  medi- 
cinal agents.    ^ 

In  most  acute  diseases  there  is  a  tendency  to  recovery  after 
a  certain  time  has  elapsed,  in  case  there  is  no  failure  in  the 
functions  of  any  of  the  essential  organs  ;  hence,  in  all  acute 
diseases,  the  state  of  the  nervous  system  should  be  carefully 
watched. 

When  the  affection  is  not  of  a  serious  character,  such  symp- 
toms as  are  especially  troublesome  may  be  relieved;  but  when 
the  nervous  and  vascular  systems  are  affected,  both  locally 
and  generally,  then  it  is  necessary  that  the  proper  measures 
for  their  relief  be  promptly  taken. 

Where  mucous  membrane  is  the  seat  of  the  affection,  it  is 
often  possible  to  remove  the  exciting  cause.  There  are  also 
many  inflammatory  affections  met  with,  where,  from  the  be- 
ginning, there  is  a  diminished  action  of  the  heart,  and  a 
depressed  state  of  the  nervous  centres.  In  the  treatment  of 
such  cases,  the  depressed  condition  of  the  general  system 
chiefly  requires  attention,  as  the  progress  and  termination  of 
the  local  affection  depend  upon  the  cause  from  which  it  has 
originated. 

There  are  also  morbid  states  not  necessarily  dependent  on 
organic  disease.  Various  acids  are  produced  by  the  fermenta- 
tion of  substances  containing  starch  or  sugar,  and  there  is 
reason  for  believing  that  an  increased  secretion  of  acid  may 
take  place  from  the  mucous  membrane  of  the  stomach  and 
produce  symptoms  of  acidity  independently  of  fermentation, 
although  one  of  the  properties  of  the  gastric  fluid  is  to  prevent 
fermentation.  The  symptoms  of  acidity  are  a  sour  taste,  and 
the  occurrence  of  acid  eructations,  often  accompanied  with 
heartburn,  and  sometimes  with  diarrhoea,  and  a  feeling  of 
sinking  at  the  epigastrium. 

In  these  cases  the  cause  must  be  sought  for,  and  such  treat- 
ment instituted  as  will  neutralize  the  acidity  and  stimulate  the 
peptic  glands  to  an  increased  secretion  of  the  digestive  fluid ; 
also  such  as  will  regulate  the  bowels.  Due  attention  must 
also  be  given  to  the  diet,  which  should  consist  of  such  sub- 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  41 

stances  as  will  not  readily  ferment,  and  all  food  containing 
starch  should  be  avoided. 

Although  topical  remedies  are  more  generally  employed  in 
the  treatment  of  dental  affections,  yet  there  are  many  diseases 
of  the  oral  cavity  which  are  due  to  remote  causes,  and  require 
constitutional  as  well  as  local  treatment. 

The  appearances  presented  by  the  mucous  membrane  of  the 
mouth  are  valuable,  as  indicating  the  state  of  other  parts  more 
remote ;  and  it  is  frequently  the  case  that,  when  the  constitu- 
tional affection  is  overcome,  the  local  symptoms  disappear  as 
a  consequence,  or  become  very  amenable  to  local  remedies. 

IMPORTANT  POINTS  IN  DIAGNOSING  AFFECTIONS  OF  THE 
MOUTH,  WITH  A  SYNOPSIS  OF  TREATMENT. 

The  Irritation  of  Teething  is  indicated  by  a  hot,  swollen  and 
tender  condition  of  the  gums,  fretfulness,  irritable  temper, 
refusal  of  nourishment,  fever  and  thirst,  and,  if  not  relieved, 
diarrhoea  with  offensive  motions,  sometimes  a  troublesome 
cough,  convulsions,  and  other  serious  results. 

An  Abnormal  Dentition  is  indicated  by  a  hot,  dry  mouth, 
swollen  gums,  tense,  tender  and  shining,  fever,  disordered 
bowels,  fretfulness,  eruption  of  skin,  diarrhcea,  convulsions. 

Convulsions  of  Dentitioji  are  indicated  by  such  premonitory 
symptoms  as  irritable  temper,  unusual  brightness  of  eyes, 
indisposition  to  eat  or  sleep,  slight  involuntary  movements  of 
muscles  of  face  or  extremities,  grinding  of  teeth.  The  par- 
oxysm is  indicated  by  rigidity  of  body,  utterance  of  a  cry, 
face  turning  red  or  purple,  veins  of  neck  turgid,  suspension  of 
respiration,  loss  of  consciousness,  irregular  and  intermittent 
contractions  of  muscles,  protrusion  of  tongue,  frothing  at  lips, 
distortion  of  face,  rolling  of  eyeballs,  contracted  and  rapid 
pulse. 

Treatment. — For  the  relief  of  the  premonitory  symptoms  of 
dentition,  bromide  of  potassium  in  doses  of  gr.  iij  to  v,  accord- 
ing to  age,  every  ten  minutes.  Demulcent  and  soothing  lotions 
to  the  gums.  An  aperient  if  no  diarrhoea  is  present.  For 
more  decided  symptoms,  scarification  or  lancing  of  the  gums. 


42  DENTAL   MEDICINE. 


An  enema  of  soap  and  water  to  relieve  the  digestive  canal  of 
irritating  substances,  or  the  use  of  the  following  combination 
to  abate  the  fever  and  allay  the  irritability  of  stomach  and 
bowels : — 

li .    Potass,  bromidi  pulv gr-xv 

Potass,  nit.  pulv gr.xij 

Zincioxidi gr.ij  M. 

Divide  in  chart.,  No.  vr, 

SiG. — One  powder  every  four  hours,  until  bedtime. 

For  the  diarrhoea  :  change  the  diet,  adopt  hygienic  measures ; 
mild  purgatives  in  small  doses.  For  acid  dejections,  calcined 
magnesia;  or  small  doses  of  sulphate  of  magnesia  and  tincture 
of  rhubarb  ;  or  of  pulv.  ipecac,  pulv.  rhubarb  and  bicarbonate 
of  soda ;  or  castor  oil  in  doses  of  5ss.  For  infancy  diarrhoeas 
Dr.  Thomas  claims  excellent  results  from  the  following  mix- 
tures in  gastric  or  gastro-intestinal  dyspepsia,  characterized 
by  nausea,  vomiting,  flatulence  and  diarrhoea  with  non-slimy, 
fetid,  yellowish  or  greenish  stools,  ^i.  Lactic  acid,  5j  ; 
simple  syrup,  5v;  water,  Siijss.  M.  Sig. — One  drachm  every 
quarter  to  half  hour  after  meals.  (See  Dr.  James  W.  White's 
recipes  under  opium,  chloroform,  aromatic  sulphuric  acid  and 
bromide  of  potassium.) 

For  convulsions  :  the  administration  of  an  anaesthetic  to 
abort  or  control  the  spasmodic  movements  ;  hydrate  of  chloral, 
gr.  V  to  X,  according  to  age,  dissolved  in  two  or  three  drachms  of 
water,  and  injected  into  the  rectum  ;  or  the  administration  of 
bromide  of  potassium  ;  use  of  hot  foot  bath,  to  which  is  added 
a  small  quantity  of  mustard ;  the  warm  bath  ;  and  when  cere- 
bral congestion  is  threatened,  cold  applications  to  the  head. 

According  to  Dr.  A.  Brothers  :  i.  Dentition  is  rarely,  if 
ever,  a  direct  cause  of  death. 

2.  Precocious  or  retarded  dentition  may  occur  in  otherwise 
healthy  children  or  in  entire  families. 

3.  The  period  of  eruption  of  the  first  teeth  occurs,  in  healthy, 
breast-fed  children,  at  six  and  a  half  months  in  the  vast 
majority  of  cases,  and  first  dentition  is  usually  complete  at 
thirty  months. 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  43 

4.  Dentition  is  distinctly  retarded  in  the  first  as  well  as  the 
later  teeth  in  children  brought  up  on  a  mixed  or  artificial 
diet. 

5.  Congenital  diseases — tuberculosis,  syphilis,  endocarditis 
— seem  to  have  a  retarding  influence  on  dentition. 

6.  Rachitis  has  a  very  pronounced  retarding  influence  on 
the  whole  course  of  dentition. 

7.  Scrofulosis  seems  to  hasten  the  eruption  of  the  first  teeth, 
but  does  not  affect  the  later  teeth. 

8.  In  cases  of  undeveloped  brain — idiocy — there  is  a  marked 
retardation  during  the  entire  period  of  dentition. 

9.  Chronic  diseases  have  a  retarding  power  over  the  first 
teeth,  but  do  not  seem  to  influence  the  later  teeth. 

10.  Children  suffering  from  marasmus  seem  to  be  precocious 
with  the  first  teeth,  but  delayed  with  the  later  teeth. 

11.  Cases  of  epilepsy,  developing  in  early  infancy,  seem  to 
have  their  first  teeth  appear  early. 

Periodofiiitis  or  Inflammation  of  the  Peridental  membrajie  is 
indicated  by  a  sense  of  uneasiness  and  fullness,  which  is  at  first 
relieved  by  pressure,  but  after  active  inflammation  is  established, 
pressure  on  the  affected  tooth  causes  intense  pain,  of  a  dull, 
heavy,  annoying  character.  The  tooth  is  also  protruded,  to  a 
slight  degree,  from  the  alveolus,  and  also  somewhat  loosened, 
owing  to  the  thickening  of  the  investing  membrane  ;  and  the 
inflammation,  which  is  at  first  manifested  by  a  red  line  near 
the  margin  of  the  gum,  becomes  general  over  the  entire  root, 
sometimes  involving  the  neighboring  gum,  and  even  the  palate 
and  cheek,  and  symptoms  of  febrile  disturbance.  If  not 
arrested,  a  suppurative  condition,  alveolar  abscess,  ensues.  A 
modification  of  the  symptoms  just  enumerated,  the  tooth  being 
tender  to  pressure,  more  or  less  raised  in  its  cavity,  and  sur- 
rounded by  a  reddened  and  swollen  gum,  with  a  varying 
amount  of  pain,  and  the  discharge  of  pus  from  around  the 
neck,  or  from  a  fistulous  opening  in  the  gum,  and  such  symp- 
toms continuing  for  a  long  time,  indicate  the  chronic  form  of 
an  advanced  state  of  periodontitis,  which  often  results  from 
systemic  influences. 


44  DENTAL   MEDICINE. 


Treatment. — Remove  all  irritants  ;  apply  counter-irritants, 
such  as  equal  parts  of  tinct.  iodine  and  tinct.  aconite  ;  or  can- 
tharidal  collodion;  or  iodine  and  creasote,  or  carbolic  acid;  or 
capsicum  in  form  of  tincture,  or  in  small  bags  of  the  powder 
to  surface  of  gum  over  root  of  affected  tooth.  Depletion  by 
the  lancet,  leeches  or  cups.  Hypodermic  injection  of  mor- 
phine, or  tinct.  of  opium.  Application  of  spray  of  rhigolene 
or  absolute  ether  until  gum  is  blanched.  To  relieve  pain,  a 
solution  of  equal  parts  of  tinct.  aconite,  tinct.  opium,  and 
chloroform ;  or  lead  water  and  tinct.  opium.  Constitutional 
treatment:  Saline  cathartics;  bromide  of  potassium,  gr.  xxv, 
combined  with  gtt.  v  of  tinct.  veratrum,  every  four  hours ;  or 
bromide  of  potassium  alone,  in  doses  of  gr.  xxv  or  xxx.  The 
tooth  protected  from  irritation  during  treatment,  by  a  cap  over 
adjoining  teeth.  The  removal  of  the  extremity  of  the  root 
of  a  tooth  affected  with  chronic  periodontitis,  by  means  of  a 
trepan,  has  also  been  suggested. 

Alveolar  Abscess  is  first  indicated  by  pain  of  a  constant  char- 
acter, which  is  afterward  aggravated  at  each  pulsation ;  then 
swelling  about  the  roots  of  the  affected  tooth,  which  at  length 
becomes  defined  and  prominent,  and  afterward  points  and  dis- 
charges pus,  when  the  active  symptoms  subside.  The  devel- 
opment of  alveolar  abscess  is  indicated  by  such  constitutional 
symptoms  as  foul  tongue,  offensive  breath,  hot  skin,  thirst  and 
headache,  and  when  the  suppuration  is  considerable,  symp- 
tomatic fever  and  rigors. 

The  characteristic  pain  of  an  alveolar  abscess  is  deep-seated 
and  throbbing,  and,  with  the  swelling,  denotes  the  formation 
of  pus.  A  chronic  form,  of  alveolar  abscess  is  indicated  by  a 
subsidence  of  the  active  symptoms,  and  a  continuance  of  the 
discharge  of  small  quantities  of  pus  through  a  fistulous  open- 
ing opposite  the  root  of  the  affected  tooth,  or  about  its  neck. 
An  elastic  fluctuating  swelling  in  any  part  of  the  face,  or  for 
some  distance  down  the  neck,  may  result  from  abscessed 
teeth. 

Treatment. — Remove  all  irritants.  Give  free  vent  for  the 
escape  of  the  pus.      Destroy  sac   of  abscess  by  therapeutic 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  45 

treatment,  or  by  a  surgical  operation.  Therapeutic  treatment: 
First  cleanse  the  root  canal  by  injections  of  chloride  of  sodium 
or  peroxide  of  hydrogen ;  then  apply  escharotics  to  destroy 
the  sac,  such  as  creasote,  carbolic  acid,  salicylic  acid,  nitrate  of 
silver,  iodine,  dilute  aromatic  sulphuric  acid,  to  which,  in  chronic 
cases,  add  tinct.  of  capsicum ;  also  antiseptics.  The  surgical 
method  consists  in  gaining  access  to  the  sac,  by  means  of  a  bis- 
toury or  small  trephine,  through  the  fistulous  opening,  where 
such  exists,  and  detaching  and  breaking  up  the  sac  by  means 
of  suitable  nerve  instruments  and  the  application  of  eschar- 
otic  agents.  Dr.  Brophy,  speaking  of  cases  of  alveolar 
abscess  where  the  disease  is  in  the  bone,  says :  "  In  such 
cases  if  the  treatment  is  simply  opening  into  the  tooth  for 
drainage  with  the  expectation  that  nature  will  effect  a 
cure,  we  will  be  disappointed.  In  such  cases  an  incision 
should  be  made  down  to  the  diseased  bone,  packing  it 
with  iodoform  gauze,  or  boracic  acid  gauze.  The  next  day 
with  a  bur  cut  off  the  affected  portion  of  the  roots  of  the 
teeth  because  they  are  a  source  of  irritation  ;  then  with  a  bud- 
bur  pass  over  the  bone,  and  remove  the  dead  portions,  and 
again  pack  the  wound  with  antiseptic  gauze.  In  a  day  or  two 
make  an  examination,  and  if  healthy  granulations  are  begin- 
ning, insert  a  wax  plug,  which  is  not  permeable  like  the  gauze, 
to  prevent  the  wound  from  closing,  and  the  consequent  trouble 
from  confined  pus." 

Alveolar  Abscess  about  to  point  Externally  is  indicated  by  the 
skin,  for  some  distance  around  the  central  point,  becoming  red 
and  distended,  with  a  throbbing  sensation,  succeeded  by  a 
change  in  the  appearance  of  the  skin  to  a  thin  and  scaly  sur- 
face, from  which  the  epidermis  scales  off.  The  integument 
becomes  glued  down  to  the  bone  around  the  spot  where  the 
pus  will  ultimately  appear;  the  latter  following  a  fistulous 
track  between  the  diseased  tooth  and  the  surface  of  the  cheek, 
the  fistula  remaining  open  and  discharging  as  long  as  the  in- 
flammatory action  continues. 

Treatment. — Make  a  free  incision  in  the  gum  opposite  and 
near  the  apex  of  the  root  of  the  affected  tooth.     Apply  to  the 


46  DENTAL  MEDICINE. 


surface  of  the  threatened  point  of  exit  of  the  pus  alcohol  or 
spirits  of  camphor,  or  paint  with  collodion,  and  make  gentle 
pressure  by  means  of  a  compress  of  sheet  lead  or  sheet  tin,  or 
pads  and  bandage,  to  change  the  direction  of  the  pus. 

Abscess  of  the  Antrum  is  indicated  by  a  discharge  of  pus  into 
the  nose,  sometimes  producing  scarcely  any  discomfort;  at 
other  times  the  severest  local  and  constitutional  suffering;  an 
aching  pain  in  the  cheek,  which  is  hot,  flushed  and  somewhat 
swollen  ;  and  as  the  symptoms  increase,  greater  pain,  of  a 
throbbing  character,  with  the  rigors  and  fever  peculiar  to 
suppuration;  an  expansion  of  the  bone  of  the  upper  jaw;  an 
elevation  of  the  malar  bone,  with  a  very  apparent  depression 
beneath  it ;  the  molar  teeth  on  the  affected  side  depressed  so 
as  to  appear  elongated,  and  to  prevent  the  proper  closure  of 
the  mouth  ;  an  increase  of  pus  ;  the  palate  losing  its  concavity 
and  becoming  convex  ;  the  nostril  of  the  affected  side  being 
encroached  upon,  and,  in  protracted  cases,  the  floor  of  the 
orbit  of  the  eye  so  pushed  up  as  to  force  the  eye  partly  from  its 
socket ;  the  sight  affected  by  the  stretching  of  the  optic  nerve ; 
the  walls  of  the  antrum  becoming  so  thin  as  to  afford  evidence 
of  fluid-fluctuation  on  pressure;  at  length  the  pus  escaping 
through  the  cheek,  or  into  the  nose,  or  burrowing  along  the 
side  of  a  root  of  a  tooth  and  discharging  into  the  mouth  ;  the 
floor  of  the  orbit  giving  way  and  the  pus  discharging  along 
the  lower  eyelid. 

Treatment. — Make  an  opening  into  the  antrum,  either 
through  the  alveolar  cavity  of  one  of  the  roots  of  a  superior 
first  or  second  molar,  or  through  the  process  about  the  roots, 
with  a  suitable  trephine,  and  thoroughly  wash  out  the  cavity 
with  a  warm  injection  of  salt  5j  to  water  Oss,  and  if  there  is 
an  offensive  odor,  syringe  with  a  solution  of  permanganate  of 
potash;  then  dress  daily  with  a  solution  composed  of  carbolic 
acid  one  part,  and  oil  of  sweet  almonds  fifteen  parts,  applied 
on  cotton  secured  in  the  cavity.  If  no  improvement,  then 
syringe  the  antrum  with  a  solution  consisting  of  carbolic  acid 
5j,  tinct.  iodine  5j,  water  Sviij.  Where  a  more  powerful  stim- 
lant  is  required,  use  an  injection  of  chloride  of  zinc,  gr.  x  to 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  47 

the  ounce  of  water.  For  systemic  treatment,  administer 
sulphide  of  calcium  in  the  form  of  one-tenth  of  a  grain  pill 
thrbe  times  a  day,  after  meals,  doubling  the  dose  if  necessary. 
{Dr.  Frank  Abbott. ) 

Alveolar  Ulceration  is  distinguished  from  alveolar  abscess 
by  the  presence  of  an  ulcerated  surface  of  peridental  membrane 
instead  of  pus  confined  in  a  fibrous  sac,  the  purulent  matter  in 
alveolar  ulceration  oozing  out  through  the  gum  or  around  the 
neck  of  the  affected  tooth  :  no  new  tissue  is  formed,  as  in  the 
case  of  abscess,  but  the  normal  tissue  is  disorganized  and 
wasted,  and  the  matter  discharged  is  watery,  translucent,  and 
may  be  in  some  cases  odorless,  while  that  from  an  abscess  is 
thick,  opaque  and  offensive.  Ulceration  causes  little  or  no 
swelling,  and  the  inflammation  is  phagedenic  in  character,  de- 
stroying hard  and  soft  tissues  by  chemical  decomposition. 
Like  alveolar  abscess,  it  may  be  due  to  the  death  of  the  pulp, 
and  it  may  begin  as  abscess,  not  being  a  primary  disease,  but 
always  preceded  by  some  other  well  established  and  usually 
chronic  affection.  In  alveolar  ulceration  a  considerable  por- 
tion of  the  peridental  membrane  is  destroyed,  and  there  is  a 
wasting  away  of  the  alveolus  and  cementum  in  the  region  of 
the  ulcer,  whereas  in  alveolar  abscess  the  peridental  membrane 
may  remain  in  an  inflamed  and  morbid  condition  and  the  alveo- 
lar walls  firm  and  penetrated  at  one  point  to  permit  of  the 
escape  of  the  pus.  In  long-continued  alveolar  ulceration,  as 
a  result  of  the  disease,  calcareous  deposits,  in  the  form  of  gran- 
ules, collect  on  the  root  from  the  ulcerated  area  to  the  margin 
of  the  gum. 

The  treatment  consists  in  the  thorough  removal  of  the  calcic 
deposit  when  present,  and  the  scraping  of  the  root  of  the  tooth 
over  the  entire  ulcerated  surface,  and  the  application  of  anti- 
septic and  astringent  remedies. 

Maxillary  Abscess  may  be  due  to  caries  or  the  diseases  of 
the  teeth,  or  to  pathological  changes  occurring  in  the  structure 
of  the  bone  itself. 

Treatment. — The  treatment  of  maxillary  abscess  consists 
either  in  puncture  or  incision,  and  the  extraction  of  one  or 


48  DENTAL   MEDICINE. 


more  of  the  teeth  if  they  are  found  to  be  connected  with  the 
origin  of  the  disease.  If  free  drainage  be  established  by  an 
early  incision,  the  arrest  of  the  disease  is  practically  secured  ; 
it  is  sometimes  necessary  to  remove  a  portion  of  the  alveolar 
process.  The  presence  of  dead  bone  should  be  determined, 
and  such  removed,  with  other  offending  matter.  Free  drain- 
age should  be  maintained  until  complete  recovery  is  brought 
about.  The  abscess  may  be  opened  under  cocaine  anaesthesia, 
a  soft  rubber  drainage  tube  be  inserted,  and  the  cavity  thor- 
oughly irrigated  and  disinfected  with  a  i  to  2,000  bichloride 
of  mercury  solution.  A  safety  pin  may  be  placed  at  the  ex- 
ternal end  of  the  tube,  and  a  strip  of  iodoform  gauze  put 
between  it  and  the  skin ;  over  this  the  ordinary  bichloride 
gauze  dressing  may  be  secured  by  a  roller  bandage. 

Necrosis  of  the  Alveolar  Process  is  indicated  by  a  dark  purple 
and  swollen  condition  of  gum,  with  offensive  purulent  discharge 
from  one  or  more  fistulous  openings,  or  from  between  the 
gums  and  the  teeth.  The  gum  becomes  soft  and  spongy,  very 
sensitive,  bleeds  readily,  and  loses  its  connection  with  the  ne- 
crosed bone  beneath. 

Treatment. — (See  Necrosis  of  the  Jaws.) 

Phosphor- Necrosis  is  indicated  by  pain  in  jaw,  similar  to 
odontalgia,  at  first  not  constant,  but  soon  becoming  severe, 
and  extending  along  side  of  the  head,  and  to  the  shoulder, 
with  swelling  and  great  tenderness  near  the  seat  of  the  affec- 
tion, the  integument  becoming  red  and  tense,  the  teeth  elon- 
gated and  extremely  painful  when  closed  together,  and  also 
becoming  loose;  the  gums  and  mucous  membrane  of  the 
cheeks  swollen  and  livid ;  at  length,  suppuration  ensues,  with 
fever,  rigors,  etc. ;  gums  become  spongy,  with  escape  of  pus 
around  necks  of  necrosed  teeth,  and  the  pus  fetid,  and  the 
swelling  very  great,  especially  when  the  lower  jaw  is  affected  ; 
a  dense  plastic  exudation  encases  the  under  and  external  sur- 
face of  the  bone  ;  intense  glistening  redness  of  the  skin,  as  the 
pus  approaches  the  surface;  at  length,  intense  fever,  with 
delirium  and  great  suffering;  the  throwing  out  of  a  bony 
deposit  of  a  peculiar  appearance,  like  pumice-stone. 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  49 

Treatmetit. — Removal  of  patient  from  exposure  to  fumes 
of  phosphorus,  and  the  excision  of  diseased  portion  of 
bone. 

Fracture  of  the  Alveolar  Process  is  indicated  by  a  swollen, 
red  and  painful  state  of  gum  and  tissues  covering  maxillary 
bone,  occurring  some  days  after  the  receipt  of  the  injury,  and, 
if  neglected,  may  result  in  necrosis  of  the  bone. 

Treatment. — Antiphlogistic  lotions,  to  reduce  the  inflamma- 
tion, such  as — 

R,     Plumbi  acetatis 3J 

Tinct.  opii 5  ss 

Aquce ^  x.    M. 

SiG. — Apply  on  lint. 

Remove  any  detached  portions  of  process,  and  secure  loose 
teeth  with  waxed  sterilized  ligatures. 

Mercurial  Poisoning,  or  Salivation,  when  of  a  mild  form,  is 
indicated  by  a  red  margin  of  the  gum,  which  eventually  be- 
comes somewhat  spongy  and  tender,  with  a  slight  fetor  of  the 
breath  and  a  metallic  taste. 

An  increased  degree  of  salivation,  or  mercurial  stomatitis,  is 
indicated  by  a  profuse  flow  of  saliva,  intense  fetor,  strong 
metallic  taste,  tenderness  of  the  gums,  stiffiiess  of  the  jaws, 
followed  by  ulceration  and  sloughing,  if  the  injudicious  use  of 
the  mercury  is  persisted  in. 

Treatment. — Discontinue  use  of  mercury.  Chlorate  of  pot- 
ash, internally,  gr.  x,  in  water  5ss :  as  a  gargle,  5j,  to  water 
5j;  or  iodide  of  potassium  in  doses  of  gr.  iij,  three  times  a 
day.  To  correct  fetor  of  breath,  permanganate  of  potash 
solution,  gr.  ij  to  x,  to  the  ounce  of  water;  or  washes  of 
chlorinated  soda ;  astringent  washes  during  convalescence. 
Loose  teeth  should  not  be  removed,  as  they  will  again  become 
firm. 

Lead  Poisoning  is  indicated  by  a  blue  line  upon  the  edge  of 
the  gums,  and  such  constitutional  symptoms  as  paralysis  and 
colic  attend  severe  cases. 

Treatme7it. — Administration  of  iodide  of  potassium  in  gr.  iij 
4 


50  DENTAL   MEDICINE. 


doses,  four  times  a  day,  after  meals,  to  eliminate  the  lead ; 
saline  cathartics,  electricity,  strychnine,  etc.,  for  the  paralysis, 
and  tonics,  such  as  quinine,  to  promote  the  strength. 

Scurvy  is  indicated  by  a  general  spongy  condition  of  the 
gums,  and,  in  severe  cases,  intense  fetor,  ulceration  and  slough- 
ing together  with  constitutional  symptoms  of  an  aggravated 
character.  The  premonitory  symptoms  in  the  mouth  are, 
gums  paler  than  usual,  with  a  slight  tumid  or  everted  line  on 
free  margins,  and  slight  tenderness  on  pressure  ;  breath  offen- 
sive, and  a  disagreeable  taste ;  tongue  flabby  and  larger,  though 
clean  and  pale.  Later,  the  gums  become  darkened  in  color, 
inflamed,  swollen,  spongy,  bleed  readily,  and  finally  separate 
from  the  teeth.  The  gums  of  edentulous  jaws  do  not  present 
these  symptoms.  At  length,  the  gums  present  great,  fungous, 
lacerable  excrescences,  which  are  prone  to  suppurate  and  be- 
come a  brown,  fetid  mass,  with  a  very  offensive  odor.  The 
salivary  glands  become  enlarged  and  swollen  ;  tongue  indented 
by  the  teeth,  which  latter  become  coated  with  a  salivary  deposit, 
and  finally  drop  out.  Necrosis  and  extensive  exfoliation  of 
the  bones  of  the  jaw  may  occur.  Some  varieties  of  salivary 
calculus  will  produce  similar  local  symptoms,  especially  when 
the  general  condition  of  the  system  is  unfavorable. 

Treatment. — Change  of  diet,  substituting  fresh  meats,  soups, 
nitrogenous  food,  and  recent  vegetable  acids,  as  citric,  tartaric, 
and  acetic,  and  these  combined  with  potassium.  Nitrate  of 
potassium,  either  alone  or  mixed  with  vinegar,  as  an  anti- 
scorbutic. 

A  Simple  Form,  of  Stomatitis  is  indicated  by  slightly  elevated, 
reddish,  glistening  patches  on  the  mucous  membrane,  which 
may  coalesce,  so  that  the  whole  surface  is  involved. 

Treatment. — Emollient  and  detergent  lotions,  such  as  slip- 
pery-elm bark,  pith  of  sassafras,  or  borax,  5j,  glycerine,  Sj,  or, 
borax,  5j,  honey,  5iij,  or  a  weak  solution  of  alum,  or  acetate  of 
lead,  gr.  iij  to  the  ounce  of  water.  A  few  doses  of  bromide 
of  potassium  will  relieve  the  nervous  excitement.  Chlorate 
of  potash  lotion,  gr.  v  to  the  ounce  of  water,  is  also  efficacious 
as  a  local  remedy. 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  51 

Ulcerous  Stomatitis,  common  to  childhood,  is  indicated  by 
ulceration  commencing  on  or  near  the  gums,  more  frequently 
in  the  lower  than  in  the  upper  jaw,  and  usually  on  one  side 
only,  and  spreading  over  the  entire  mouth.  The  gum  first 
becomes  thickened  and  congested,  and  of  a  deep  purple  color, 
and  bleeds  readily ;  ulceration  speedily  occurs,  and  exposes 
the  necks  of  the  teeth,  and  extends  to  the  mucous  membrane 
of  the  mouth  generally,  the  ulcerated  surface  being  covered 
with  a  dirty-white  or  yellow  exudation,  leaving  exposed  numer- 
ous bright  red  points  on  a  yellowish  ground.  The  edges  of 
the  ulcers  are  sharp  and  ragged,  and  the  ulcer,  at  first  super- 
ficial, becomes  gradually  deeper.  Ulcers  of  the  mouth  are 
often  due  to  syphilis  and  dyspepsia,  and  are  aggravated  by  the 
irritation  resulting  from  the  irregular  edges  of  fractured  and 
decayed  teeth.  When  neglected,  such  ulcers  may  assume  the 
appearance  of  epithelioma,  especially  when  induration  of  the 
glands  beneath  the  jaw  is  present. 

Treatment. — Remove  all  apparent  causes  of  irritation. 
Change  diet  and  residence,  if  at  fault,  observe  cleanliness, 
administer  tonics,  as  liquor  ferri  nitratis  with  tincture  of 
calumba.  Local  applications  of  nitrate  of  silver,  gr.  j  to  iij  to 
the  ounce  of  water,  or  diluted  muriatic  acid,  alternating  with 
a  lotion  of  equal  parts  of  borax  and  honey,  or  chloride  of  lime, 
5j,  honey,  5j.  Chlorate  of  potash  internally,  in  doses  of  5ij  or 
iij,  and  also  as  a  lotion,  is  efficacious  ;  also  a  strong  solution  of 
borax,  in  obstinate  cases,  gr.  xv  to  the  ounce  of  water;  also  a 
.solution  of  sulphate  of  copper. 

Ulcers  of  the  Month  due  to  Syphilis  are  indicated  when  such 
ulceration  is  obstinate  under  any  but  specific  treatment,  and 
when  accompanied  by  symptoms  peculiar  to  syphilis. 

Treatment. — Constitutional  treatment  with  mercury  or  iodide 
of  potassium,  and  such  local  remedies  as  are  employed  in 
ulcerous  stomatitis. 

Syphilitic  Inflammation  of  the  Mucons  Membrane  of  the 
Month  is  indicated  by  a  general  swelling  of  the  gums,  with 
everted  and  ulcerated  margins,  exposing  the  necks  of  the  teeth, 
although  not  affecting,  to  any  great  degree,  their  stability,  with 


52  DENTAL   MEDICINE. 


a  viscid  discharge,  mixed  with  blood,  from  about  their  necks  ; 
soreness,  rendering  mastication  painful ;  the  affection  slowly 
spreading,  until  the  bone  is  exposed  and  a  portion  exfoliated ; 
greater  degree  of  congestion;  formation  of  mucous  patches 
on  sides  of  cheeks ;  superficial  ulcers  inside  of  cheeks  and 
beneath  the  tongue ;  erosions  of  the  soft  palate  and  tonsils  : 
fissures  at  corner  of  the  mouth,  and  eruptions  on  skin  and 
scalp. 

Treatment. — (See  Ulcers  of  the  Mouth  due  to  Syphilis.) 

Gangrenous  Stomatitis,  common  to  children  during  the 
shedding  of  the  temporary  teeth,  is  indicated  by  a  thick  swell- 
ing of  the  face ;  skin  tense  and  shining ;  swelling  becoming 
hard  and  circumscribed,  but  devoid  of  tenderness,  with  a 
central  spot,  red  and  variegated  in  appearance  ;  the  formation 
of  an  ulcer,  corresponding  to  the  red  spot  outside,  on  the  inside 
of  the  cheek ;  profuse  salivation,  the  ulcerated  part  becoming 
gangrenous,  with  an  opening  through  the  cheek ;  absence  of 
pain  and  destruction  of  parts. 

Treatment. — Preventive :  Pure  air,  cleanliness,  nourishing 
diet.  Sulphate  of  quinine,  internally,  in  doses  of  gr.  ij  to  iij  ; 
and  as  a  lotion,  sulphate  of  zinc,  5j  to  the  ounce  of  water. 
When  the  disease  is  established,  the  local  use  of  escharotics, 
as  acetic,  sulphuric,  nitric,  hydrochloric  acids,  nitrate  of  silver, 
acid  nitrate  of  mercury,  or  chloride  of  antimony,  each  applied 
by  means  of  a  camel-hair  brush  to  gangrenous  part,  and  at 
once  followed  by  the  application  of  dry  chloride  of  lime.  The 
mouth  to  be  washed  out  with  tepid  water,  by  means  of  a 
syringe.  After  the  separation  of  the  slough,  the  dry  chloride 
of  lime  alone  may  be  used.  The  muriated  tincture  of  iron  is 
also  employed ;  and  after  the  gangrene  is  arrested  astringent 
lotions  are  efificacious. 

Scrofula. — In  early  life  the  characteristics  are  most  appar- 
ent. Tendency  to  enlargement  of  lymphatic  glands ;  pro- 
clivity to  certain  forms  of  skin  eruption ;  to  disease  of  the 
joints  and  bones  ;  the  efforts  necessary  for  growth  and  develop- 
ment overtax  the  defective  vital  powers  ;  defective  quality  of 
the  blood  and  tissues,  and  especially  of  the  vascular  tissue ; 


DIAGNOSIS   OF  MOUTH   AFFECTIONS.  53 

injuries  such  as  sprains  end  in  chronic  disease  of  the  joint.  A 
scrofulous  child  may  grow  finely  for  several  years,  and  then, 
without  adequate  cause,  be  overtaken  by  meningitis,  or  disease 
of  vertebrae  :  inflammations  are  prone  to  take  on  chronic  form. 

Treatment. — Pure  air  of  country,  cod-liver  oil  and  malt, 
iron  and  hypophosphites  to  increase  the  quantity  of  nutritious 
constituents  of  the  blood. 

A  Tumor  of  the  Upper  Jaw  xs  indicated  by  a  gradually  in- 
creasing prominence  of  the  cheek,  which  more  or  less  involves 
the  mouth,  obstructing  the  nostril,  causing  double  vision  by 
displacing  the  eyeball. 

Treatment. — Removal  by  a  surgical  operation. 

A  Malignajit  Form  of  Tumor  of  the  Jaws  is  indicated  by  a 
solid  prominence,  rapid  in  growth,  and  having  a  tendency  to 
invade  surrounding  structures,  and  to  fungate  like  a  mush- 
room. 

Treatment. —  Removal  by  a  surgical  operation,  and  the  ap- 
plication of  escharotics,  as  chromic  acid,  or  chloride  of  zinc, 
etc.,  to  prevent  its  reproduction. 

A  Dentigeroiis  Cyst. — Cysts  of  the  teeth  are  of  two  kinds — 
those  connected  with  the  roots  of  developed  or  erupted  teeth, 
and  those  connected  with  imperfectly  developed  or  unerupted 
teeth,  and  both  varieties  are  common  to  either  jaw;  the  latter, 
however,  are  known  as  "dentigerous  cysts."  A  dentigerous 
cyst  is  indicated  by  the  expansion  of  the  bone  of  the  jaw  at 
some  particular  spot,  with  disfigurement  of  the  adjacent  parts; 
a  sense  of  weight  and  tension  in  the  aflfected  part;  in  some 
cases,  constitutional  irritation  from  pressure;  pressure  pro- 
ducing a  parchment-like  crackle  or  crepitation  ;  absence  of  a 
tooth,  which  has  never  been  erupted  nor  extracted.  Heath 
remarks  that  "the  clinical  history  of  cysts  connected  with  the 
teeth  is  that  of  painless  expansion  of  the  alveolus  of  either 
jaw,  but  more  frequently  of  the  upper,  with  crackling  of  the 
bone  on  pressure,  and  ultimate  absorption  of  the  bony  wall. 
The  cyst  then  presents  a  bluish  appearance  through  the  dis- 
tended mucous  membrane,  and  if  large,  gives  distinct  evidence 
of  fluctuation." 


54  DENTAL   MEDICINE. 


Treatment. — A  free  incision,  and  the  removal  of  the  unerupted 
tooth  by  destroying  the  front  wall  of  the  cyst,  and  the  cavity 
filled  with  lint,  so  as  to  induce  granulation  and  gradual  oblit- 
eration. In  the  case  of  a  cyst  of  the  lower  jaw,  after  the  re- 
moval of  the  contents  and  a  portion  of  the  wall,  the  plates  of 
bone  should  be  pressed  together  as  much  as  is  possible. 

An  Unerupted  Impacted  Tooth  is  indicated  by  a  hard  bony 
tumor  on  the  alveolar  ridge,  sometimes  extending  along  the 
surface  of  the  palate  bone,  or  the  body  of  the  maxilla,  and  in 
form  corresponding  to  a  tooth,  the  absence  of  which  is  noted. 

Treatment. — Extraction,  by  first  making  an  incision  through 
the  mucous  membrane,  and  then  exposing  the  tooth  by  the 
removal  of  its  bony  capsule. 

Necrosis  of  the  Jaw  is  indicated  by  inflammation  like  that  of 
periodontitis  in  the  early  stage,  but  differing  as  the  disease 
progresses ;  gum  over  affected  part  thickened,  tumid  and  of  a 
red  color;  pus  oozing  from  the  edge  of  gum,  which  soon  sep- 
arates from  the  alveolus,  the  margins  of  which  become  ex- 
posed; loosening  and  loss  of  the  teeth;  the  detachment  of 
the  dead  alveoli  from  the  living  bone,  and  remaining  loose  in 
the  substance  of  the  thickened  gum  which  becomes  dark  in 
color,  surrounded  by  pus ;  the  escape  of  the  pus  into  the 
mouth,  or  pointing  below  the  chin,  or  beneath  the  fascia  of 
the  neck,  as  low,  at  times,  as  the  clavicle. 

Treatment. — Remove  the  dead  portions  from  the  living  bone. 
Syringe  with  peroxide  of  hydrogen  to  cleanse  the  part,  and  use 
chlorinated  washes,  such  as  chloride  of  soda,  or  permanganate 
of  potash,  to  correct  the  offensive  odor  and  disagreeable  taste. 
Make  daily  applications  of  dilute  aromatic  sulphuric  acid,  add- 
ing to  the  acid  a  few  drops  of  the  tincture  of  capsicum  for  its 
stimulating  effect ;  diluted  carbolic  acid,  tincture  of  iodine  and 
chloride  of  zinc,  sulphate  of  copper,  listerine  and  ethereal  solu- 
tion of  iodoform,  aristol,  etc.,  are  also  used  as  applications. 
Support  the  strength  by  stimulants,  tonics  and  nourishing  diet. 

Dislocation  of  the  Lower  Jaw,  when  double,  is  indicated  by 
inability  to  close  the  mouth ;  the  mouth  widely  open ;  the 
chin  prominent,  with  a  distinct  hollow  in  front  of  each  ear. 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  55 

A  single  dislocation  is  indicated  by  the  mouth  being  only  par- 
tially open,  the  chin  displaced  to  one  side,  the  distinct  hollow 
below  the  ear  being  on  the  opposite  side. 

Treattnent. — Reduction  is  made  by  placing  the  thumbs, 
protected  by  napkins,  as  far  back  upon  the  molars  as  possible, 
and  then  depressing  the  back  part  of  the  jaw,  and  at  the  same 
time  raising  the  chin.  The  jaws  should  afterward  be  secured 
by  a  bandage  extending  under  the  chin  and  over  top  of  head. 

Fracture  of  the  Lower  Jaiv  is  indicated  by  inability  to  close 
the  mouth,  and  to  speak  articulately;  laceration  of  the  gums 
and  hemorrhage ;  irregularity  of  the  teeth  from  displacement 
of  the  fragments  of  bone ;  crepitation.  Fracture  of  the  maxilla 
may,  however,  show  no  displacement,  or  the  fracture  extending 
through  the  angle  or  ramus,  may  be  diagnosed  by  grasping 
the  two  sides  of  the  jaw  and  moving  them  forcibly.  Crepitus, 
increased  flow  of  saliva,  mobility  of  fragments,  and  irregularity 
of  the  teeth,  if  the  fracture  is  through  the  body  of  the  bone, 
are  all  signs  of  fracture.  A  swollen,  red  and  painful  condition 
of  the  tissues  covering  the  lower  jaw,  occurring  some  days 
after  the  accident,  denote  the  possibility  of  fracture,  neglect 
causing  a  high  degree  of  inflammation,  and  in  some  cases 
even  necrosis  of  the  bone. 

Treatment. — Reduce  by  bringing  the  displaced  portions  into 
apposition,  being  guided  by  the  arch  of  the  teeth,  and  then 
securing  them  by  wire,  silk,  or  waxed  sterilized  ligatures 
around  the  teeth,  and  introducing  an  interdental  splint. 

Cleft  Palate  is  indicated  by  a  fissure  extending  through  the 
soft  palate  alone,  or  through  both  soft  and  hard  palates,  and 
which  may  be  combined  with  single  or  double  hare-lip,  in 
which  case  the  intermaxillary  bones  are  frequently  displaced. 

Treatment. — When  the  cleft  is  confined  to  the  soft  palate, 
the  operation  of  staphylorraphy  may  be  performed ;  when, 
however,  the  cleft  is  through  both  soft  and  hard  palates,  the 
construction  of  an  artificial  obturator  and  palate  combined 
will  often  prove  successful  in  correcting  the  voice  and  prevent- 
ing much  inconvenience  in  partaking  of  food  and  drink. 

Hare-lip  is  indicated  by  a  congenital   fissure  of  the  upper 


56  DENTAL   MEDICINE. 


lip,  and  may  be  single  or  double,  and  may  also  be  complicated 
with  fissure  of  the  hard  and  soft  palates. 

Treatment. — Pare  the  surfaces  of  the  edges  of  the  fissure  in 
such  a  manner  as  will  allow  a  flap  on  one  to  cover  the  edge 
of  the  other  when  they  are  brought  in  apposition,  when  they 
are  secured  by  the  aid  of  pins  and  the  figure-of-eight  suture, 
which,  in  the  case  of  infants,  may  be  preserved  from  injury  by 
passing  a  silver  wire  through  the  cheeks,  having  on  each  pro- 
truding end  a  button,  to  prevent  the  breaking  up  of  the  suture 
during  the  act  of  crying.  Cocaine  is  a  useful  local  anaesthetic 
for  such  operations. 

Facial  Paralysis  is  indicated  by  distortion  of  the  face,  in 
which  the  mouth  is  drawn  to  one  side,  being  due  to  paralysis 
of  the  facial  nerve.  The  eye  may  also  remain  permanently 
open  on  the  affected  side,  the  saliva  escape  from  the  corner  of 
the  mouth,  and  the  food  collect  under  the  cheek,  on  account 
of  the  paralysis  of  the  buccinator  muscle. 

Treatment. — Electricity,  and  systemic  treatment  with  strych- 
nine, phosphorus,  iron,  quinine,  ergot,  etc. 

A  Nasal  Polypus  is  indicated  by  more  or  less  obstruction  of 
one  or  both  nostrils,  with  occasional  watery  discharge ;  a  gray 
or  yellowish  mass,  like  jelly  in  consistence,  can  be  detected 
by  the  finger,  if  it  is  passed  behind  the  soft  palate,  hanging 
down  into  the  pharynx,  and  which  greatly  increases  in  damp 
weather ;  the  nose  bulged  out  on  one  side  by  the  growth 
within. 

Treatment. — Remove  either  by  the  snare  or  by  torsion,  or 
by  repeated  applications  of  chromic  acid.  To  prevent  repro- 
duction apply  to  the  surface  chromic  acid  or  chloride  of  zinc. 

Thrush,  common  to  infants  and  children  under  eighteen 
months  of  age,  is  indicated  by  small,  white  spots,  the  size  of  a 
pin's  head,  upon  the  dorsal  surface  of  the  tongue,  palate,  velum, 
inside  of  cheek  and  lips,  which  increase  in  size  and  coalesce, 
with  a  tendency  to  false  membrane,  the  crusts  falling  off  and 
reappearing ;  the  mucous  membrane  beneath  redder  than  nat- 
ural. 

Treatment. — Change  of  diet  and  residence,  if  these  are  at 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  57 

fault ;  the  administration  of  saccharate  of  lime  in  milk.    Local 
treatment,  mel-boracis,  or  borax  solution,  or — 

R.     Sodii  borat ,^j 

GlycerinDe ^ij 

Aquae ^iv.    M. 

SiG. — Apply  with  a  camel's-hair  brush  four  or  five  times  a  day. 

Or— 

B .     Zinc  sulph grij-iv 

Aquae  rosae ^ij.    M. 

Or  a  weak  solution  of  nitrate  of  silver. 

Aphtha  or  Follicular  Ulceration^  common  to  childhood,  is 
indicated  by  the  mucous  membrane  becoming  inflamed,  and 
the  formation  of  small,  round,  transparent  vesicles  on  the 
fraenum,  in  the  sulcus  between  the  lips  and  gums,  and  on  lower 
surface  of  tongue.  On  the  bursting  of  the  vesicles,  small, 
spreading  ulcers,  with  red  and  swollen  margins,  appear,  which 
become  coated  with  a  layer  of  o'idium  albicans. 

Treatment. — Demulcent  applications,  such  as  mucilage  of 
gum  acacia,  or  flaxseed,  Mel-boracis  applied  with  a  camel's- 
hair  brush.  For  constitutional  symptoms,  administer  laxatives 
and  the  bromides,  with  warm  foot  bath. 

Epulis  is  indicated  by  a  growth  on  the  gums,  either  small 
and  pedunculated,  or  large  and  sessile. 

If  it  is  firm  in  texture  and  slow  of  growth,  the  epulis  is 
generally  fibrous ;  but  if  rapid  in  growth  and  dark  in  color,  it 
is  myeloid  ;  if  prone  to  ulcerate  and  very  painful,  it  may  be  an 
epithelioma. 

Treatme7it. — Removal  of  the  growth,  and  its  reproduction 
prevented  by  the  application  of  nitrate  of  silver,  or  chromic 
acid,  or  a  fire  cautery.  Generally,  it  is  necessary  to  remove 
the  periosteum  and  a  thin  scale  of  the  bone  beneath,  as  this 
growth  is  connected  with  the  periosteum.  Extract  all  roots  of 
carious  teeth,  and  when  the  epulis  is  connected  with  the  alve- 
olar cavity  of  a  tooth  and  has  tendency  to  the  interior  of  the 
jaw,  it  is  generally  myeloid,  and  several  teeth  will  have  to  be 
sacrificed,  so  that  the  alveolus  can  be  thoroughly  excavated. 


58  DENTAL   MEDICINE. 


When  very  extensive,  a  considerable  portion  of  the  alveolus 
and  bone  of  the  jaw  must  be  removed. 

Epithelioma  is  indicated  by  a  ragged  ulcer  on  the  lower  lip, 
commencing  as  a  wart,  the  skin  around  being  hard  and  infil- 
trated, with  enlargement  of  the  submaxillary  lymphatic  glands, 
which  become  tender,  or  even  ulcerated. 

Epithelioma  of  the  gum  is  in  the  form  of  a  ragged  ulcera- 
tion, often  the  result  of  irritation  from  diseased  teeth ;  the  pain 
and  inconvenience  at  first  slight ;  a  tending  of  the  ulceration  to 
spread  toward  the  tongue  and  cheek,  with  induration  of  the 
base  of  the  ulcer. 

Treatment. — Removal  as  soon  as  its  nature  is  manifest.  In 
slight  or  doubtful  cases  the  application  of  the  strongest  nitric 
acid,  the  acid  nitrate  of  mercury,  or  the  actual  cautery,  to 
bring  about  a  healthy  cicatrization.  If  the  disease  has  involved 
the  alveolus,  as  is  evident  by  the  swelling  of  the  gum  and  the 
looseness  of  the  teeth,  a  free  removal  of  the  bone  is  necessary. 

Hypertrophy  of  the  Gtims  is  indicated  by  an  increase  of  their 
substance  to  such  a  degree  as  to  cause  them  to  overhang  and 
cover  the  greater  portion  of  the  crowns  of  the  teeth  ;  tendency 
to  hemorrhage;  gums  dark  and  livid ;  fetor  of  breath  ;  increased 
flow  of  saliva. 

Treatment. — Remove  all  dead  teeth  and  salivary  calculus. 
Remove  the  morbid  growth  by  a  horizontal  incision  through 
the  diseased  structure  to  the  crowns  of  the  teeth,  and  freely 
scarify  the  gums  by  passing  a  lancet  between  the  teeth  to  the 
process,  and  repeat  this  operation  at  intervals  of  four  or  five 
days,  if  necessary.  Use  detergent  and  astringent  lotions,  and 
occasionally  a  weak  solution  of  nitrate  of  silver.  Phenate  of 
soda  is  efficacious  as  a  lotion,  also  antiseptic.  Diet  non-irri- 
tating, and  all  excess  and  intemperance  avoided.  The  teeth 
should  be  kept  perfectly  clean. 

Alveolar  Pyorrhoea,  or  Riggs'  Disease,  is  indicated  at  first  by 
an  uneasy  sensation ;  then  inflammation  of  margins  of  gums  ; 
looseness  of  the  gums  about  the  teeth,  which  form  pockets ; 
and  necrosis  of  edges  of  alveolar  process ;  a  tendency  to 
hemorrhage ;  inflammation  extending  deeper  into  gums  ;  small 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  59 

sulci  filled  with  pus  ;  looseness  of  the  teeth  and  change  of  posi- 
tions ;  disagreeable  taste  ;  peculiar  fetor  of  breath  ;  dark  livid 
color  of  gums,  with  thick  margins,  and  often  extreme  sensitive- 
ness to  touch  ;  in  some  cases  the  gums  are  denuded  of  their 
epithelium,  with  a  polished  appearance,  in  others,  with  a  pimpled 
surface ;  the  teeth,  at  length,  held  in  their  cavities  by  a  tough, 
ligamentous  attachment,  due  to  the  change  occurring  in  the 
peridental  membrane. 

A  simple  form  of  this  disease  may  manifest  itself  at  the 
margin  of  the  gum,  indicating  its  presence  by  a  congested 
appearance,  beneath  which  may  be  found  a  granule  of  calcified 
material.  While  in  many  cases  there  is  general  congestion  of 
the  affected  gum,  and  a  proneness  to  hemorrhage,  in  other 
cases  the  gum  may  present  an  anaemic  appearance — pale  and 
bloodless.  This  disease  may  also  be  associated  with  syphilis, 
mercurial  salivation  and  scurvy.  The  deposit  of  salivary  cal- 
culus or  other  calcified  substance  is  supposed  to  be  secondary  to 
the  disease,  as  a  deep-red  and  denuded  gum  tissue  about  the 
necks  of  the  teeth  may  be  present  without  any  deposit. 

Dr.  Chas.  B.  Atkinson  describes  this  affection  as  follows: — 
"  Perhaps  the  earliest  condition  presented  to  us  is  a  tumefac- 
tion of  the  margin  of  the  gum — from  pearly-red  and  light  lilac 
to  purplish  blue  in  tint — sometimes  puffing  to  such  an  extent 
as  to  be  easily  confounded  with  an  alveolar  abscess.  The 
tumefied  gum  bleeds  readily  on  brushing.  A  probe  passed 
carefully  under  the  gum  will  disclose  a  pocket  embracing  more 
or  less  the  circumference  of  the  root,  in  some  places  nearly  or 
quite  to  its  apical  end.  Sometimes  the  gum  will  be  found  re- 
ceded, perhaps  on  one  side  only.  A  purulent  discharge  more 
or  less  marked,  may  be  demonstrated  by  pressure  of  the  finger 
over  the  root,  from  its  end  towards  the  crown  of  the  tooth.  A 
further  demonstration  of  the  pressure  of  pus  may  be  secured 
by  injection,  about  the  necks  of  the  teeth,  of  peroxide  of  hy- 
drogen. A  general  hypertrophy  of  the  oral  tissues  may  be 
noticed.  Suppuration,  perhaps  preceding,  perhaps  following, 
a  solution  of  the  dental  ligament,  which  permits  the  pocket  to 
be  formed,  and  is  the  antecedent  usually  responsible  for  the 


60  DENTAL   MEDICINE. 


loosening  of  the  teeth.  This  loosening  may,  however,  be  pre- 
sent as  a  result  of  inflammation  before  suppuration  has  suc- 
ceeded. The  loosening  may  be  attended  with  recession  of  the 
gum  or  not,  and  with  or  without  pain.  Locally,  aside  from 
the  gingival  congestions  already  noticed,  the  teeth  may  be 
found  elongated,  the  breath  fetid,  tartar  freely  present  (although 
many  cases  progress  to  disaster  with  no  appreciable  deposit  of 
tartar),  pus  sometimes  oozing  from  the  sockets,  putrid  taste  in 
the  mouth,  tenderness  of  the  teeth,  already  noted,  and  many 
times  considerable  irregularities,  the  natural  result  of  the 
loosening  of  the  teeth.  Observation  may  disclose  such  sys- 
temic conditions  as  stomach  dyspepsia,  catarrh  (as  nasal  ca- 
tarrh or  other  mucous  surface  debility),  constipation,  phthisis, 
adenoid  growths,  general  congestion  due  to  intemperance, 
kidney  disease,  rheumatism,  cold  feet  and  other  extremities, 
indicating  poor  circulation  and  malassimilation.  Dr.  Rhein 
has  truly  said  that  incurable  systemic  disorders  make  only 
palliation  of  pyorrhoea  disorders." 

Treatment. — The  first  and  most  important  matter  is  to  remove 
all  deposits  from  the  roots  of  the  teeth,  and  all  necrosed  bone 
from  the  margins  of  the  alveolar  processes.  This  can  be 
accomplished  with  what  are  known  as  Riggs'  instruments.  An 
acquired  and  acute  sense  of  touch  is  necessary  to  determine 
the  thoroughness  of  the  cleansing  operation.  The  pockets 
formed  in  the  gum  may  then  be  treated  with  iodoform  and 
eucalyptus,  iodoform  and  oil  of  cinnamon,  or  with  injections  of 
chloride  of  alumina,  gr.  iij  to  the  ounce  of  water,  also  strong 
tincture  of  myrrh,  aromatic  sulphuric  acid.  Peroxide  of 
hydrogen,  and  also  a  solution  of  iodide  of  zinc,  gr.  xii-xiv  to 
the  ounce  of  water,  are  also  recommended  by  Dr.  Harlan,  in 
the  form  of  injections ;  and  for  chronic  cases  the  latter  in  a 
solution  composed  of  gr.  xxiv  to  the  ounce  of  water,  after  the 
parts  are  cleansed  by  injections  of  the  peroxide  of  hydrogen. 
Another  method :  After  thorough  removal  of  deposits,  syringe 
with  aromatic  sulphuric  acid,  diluted  with  one-half  water,  and 
apply  night  and  morning  a  powder  composed  of  creta  prepar- 
atse,  Sj;  acidum  boricum,  Sj.     The  use  of"  Robinson's  Reme- 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  61 

dy  "  is  also  recommended,  following  the  use  of  bichloride  of 
mercury  i  to  500. 

Dr.  Chas,  B.  Atkinson  recommends  first  returning  loose 
teeth  to  place  laterally,  and  securing  them  with  waxed  steril- 
ized ligatures.  Then,  beginning  with  the  upper  jaw,  such  seal- 
ing as  may  be  indicated  should  be  performed,  after  which  the 
pockets  should  be  carefully  investigated  with  proper  instru- 
ments, all  foreign  matter  removed  from  them  and  from  about 
the  teeth,  having  recourse  frequently  to  a  sirs  or  ts'ss  solution 
of  HgClj  in  H2O2.  This  preparation  of  peroxide  should  be 
first  allowed  to  remain  in  the  pockets  and  about  the  teeth  for 
perhaps  even  three  minutes.  It  may  be  necessary  to  reduce 
the  length  of  elongated  teeth,  but  if  direct  pressure  will  an- 
swer, this  should  be  resorted  to  and  shortening  of  the  bite 
avoided.  See  the  patient  daily  for  two  weeks.  Sometimes  no 
application  of  medicaments  will  be  indicated — perhaps  a  little 
scaling  or  scraping  of  overlooked  deposit,  from  time  to  time. 
The  appearances  of  the  abnormal  conditions  seem  to  be  best 
indicated  by  color,  size  and  texture.  A  dark  blue  color  of 
soft  and  spongy  gum  should  be  lanced  to  relieve  the  venous 
congestion,  and  then  injected  with  aromatic  sulphuric  acid, 
full  officinal  strength.  Should  suppuration  be  imminent  or 
present,  the  pus  should  be  evacuated  by  incision,  or  by  the  in- 
jection of  peroxide  of  hydrogen  as  a  first  step,  followed  by  a 
delicate  application  of  "caustic  paste"  (potassa  fusa  ^,  car- 
bolic acid,  cryst.  }^).  A  cherry-red  color  of  slightly  puffed 
gum  calls  for  salicylic  acid  solution  saturated  in  95  per  cent,  al- 
cohol. The  constant  exhibition  of  antiseptic  and  stimulant 
mouth-washes  is  necessary,  such  as  combinations  of  bichloride 
of  mercury,  tincture  of  calendula  and  distilled  water,  or  hy- 
dronaphthol,  tincture  of  calendula  and  distilled  water;  or  per- 
oxide of  hydrogen  and  tincture  of  calendula.  Systemic 
remedies  are  also  indicated,  such  as  tonics  and  cathartics,  the 
latter  in  the  beginning  of  the  treatment;  also  digestive  stimu- 
lation. 

Dr.  E.  C.  Kirk  recommends  a  ten  per  cent,  solution  of  aris- 
tol,  rubbed  up  with  oil  of  cinnamon,  or  oil  of  gaultheria  and 


62  DENTAL   MEDICINE. 


introduced  into  each  suppurating  pocket,  and  around  the  roots 
of  the  teeth  a!t  the  base  of  each  pocket,  on  wisps  of  absorbent 
cotton,  saturated  with  the  solution. 

Irritation  of  the  Dental  Pulp  is  indicated  by  an  uneasy  sen- 
sation, which  develops  into  pain  of  a  gnawing  or  burning  char- 
acter, the  affected  tooth  being  sensitive  to  changes  of  temper- 
ature, painful  in  mastication,  but  exhibiting  no  symptoms  of 
inflammation  of  the  gum  or  peridental  membrane. 

Treatment. — The  treatment  must  vary  with  the  condition 
producing  the  affection.  First  remove  all  irritants.  If  the 
cause  is  systemic,  constitutional  treatment  for  the  condition 
present  is  indicated.  Saline  cathartics,  as  the  sulphate  or 
carbonate  of  magnesia;  diaphoretics,  as  spts,  mindererus,  or 
Dover's  powder;  diuretics,  as  preparations  of  nitre,  often  prove 
efficacious ;  also  bromide  of  potassium.  If  the  fluids  of  the 
mouth  are  irritative,  they  must  be  corrected.  If  a  carious 
cavity  exists,  all  foreign  substances  and  the  softer  parts  of  carious 
dentine  should  be  removed,  and  the  cavity  syringed  with  a  tepid 
solution  of  bicarbonate  of  soda,  potash  or  ammonia.  Dilute  car- 
bolic acid,  or  wood  creasote,  may  then  be  applied,  and  a  non- 
conducting filling  of  a  solution  of  gutta  perchaand  chloroform  be 
introduced.    (See  Dental  Formulse  for  Odontalgia  and  Pulpitis.) 

Acute  Inflammation  of  the  Dental  Pulp  is  indicated  by  acute 
pain  in  the  affected  tooth,  which  frequently  extends  to  neigh- 
boring teeth  and  to  the  side  of  the  face,  but  is  more  intense  in 
the  tooth  itself;  pain  may  subside  after  a  few  hours'  duration, 
to  return  again  on  the  slightest  provocation,  or  on  patient 
assuming  a  horizontal  position ;  the  pain  may  also  assume  a 
throbbing  character. 

Treatment. — The  treatment  of  this  condition  of  pulp  is  indi- 
cated in  that  of  "  irritation  of  the  pulp."  For  soothing  appli- 
cations, solution  of  gutta  percha  and  chloroform,  tincture  of 
hamamelis  applied  warm,  oil  of  cloves,  dilute  creasote,  equal 
parts  of  chloroform,  aconite  and  tincture  of  opium,  may  be 
employed.     (See  Dental  Formulae  for  Pulpitis  and  Odontalgia.) 

Chronic  Inflammation  of  the  Dental  Pulp  is  indicated  by  pain, 
less  severe  than  in  the  acute  form,  and  of  less  duration;  coming 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  63 

on  at  irregular  intervals,  and  wandering,  like  neuralgic  pains, 
and  incited  by  changes  of  temperature,  and  the  application  of 
irritants.     (See  Irritation  of  Dental  Pulp.) 

Fungous  Groii'th  of  Pulp  is  indicated  by  the  organ,  as  a  result 
of  continued  irritation,  assuming  the  form  of  a  small  vascular 
tumor,  or  granular  mass,  attached  by  means  of  a  pedicle, 
which,  in  some  cases,  completely  fills  the  cavity  of  decay  in  the 
crown  of  the  tooth,  and  is  often  extremely  sensitive  and  prone 
to  hemorrhage. 

Treat)ne7it. — When  a  tendency  to  fungous  growth  is  dis- 
covered, the  free  application  of  carbolic  acid  or  tincture  of 
aconite  followed  by  the  use  of  chromic  acid,  will  obtund  the 
sensibility,  when  the  entire  tumor  should  be  excised,  and  its 
reproduction  prevented  by  application  of  nitric  acid  on  a  disc 
of  card-board. 

Ossification  of  the  Dciital  Pulp  is  indicated  by  pain  of  a 
neuralgic  character,  which  commences  in  an  uneasy  feeling, 
and  changes  to  what  has  been  described  as  a  gnawing  sensa- 
tion, similar  to  that  which  attends  the  knitting  together  of  the 
fractured  parts  of  a  bone.  It  may  be  continuous,  but  not 
constantly  severe,  and  frequently  amounts  to  no  more  than  an 
uneasy  sensation ;  at  other  times  it  may  be  sharp  and  darting, 
affecting  the  side  of  the  head,  and  all  the  branches  of  the  supe- 
rior maxillary  division  of  the  fifth  pair  of  nerves.  The  affected 
tooth  is  free  from  soreness  and  discoloration. 

Treatment. — Apply  anodynes,  such  as  lead  water,  and  those 
indicated  in  "  acute  inflammation  of  pulp  "  to  relieve  the  pain. 
Open  the  pulp  chamber,  and  completely  extirpate  the  pulp. 

Abnormal  Sensibility  of  De^itine  is  indicated  by  pain  resulting 
from  irritation  of  dentinal  structure,  being  of  shorter  duration 
and  less  acute  in  character  than  that  from  an  inflamed  dental 
pulp;  the  pain  of  sensitive  dentine  soon  subsides  on  the 
removal  of  the  irritating  cause. 

Treatment. — Apply  obtunding  agents,  as  chloride  of  zinc, 
chloroform  and  aconite  equal  parts,  carvacrol,  oil  of  cloves,  oil 
of  cedar,  oil  of  eucalyptus,  tannin  combined  with  glycerine  or 
camphor,  chloral,  camphorized  ether,  oxide  of  calcium,  car- 


64  DENTAL   MEDICINE. 


bonate  of  sodium,  menthol,  thymol,  sesquichloride  of  chromium, 
sulphate  of  morphine  and  gum  camphor  equal  parts,  ethylate 
of  sodium,  carbonate  of  potash  and  glycerine,  carbolized  potash, 
campho-phenique,  etc.  Ottolengui's  method :  Apply  the  rubber- 
dam,  dry  cavity  with  bibulous  paper,  then  insert  a  pledget  of 
cotton  saturated  with  absolute  alcohol,  then  apply  intermittingly 
a  series  of  blasts  of  hot  air  to  produce  evaporation,  until  parts 
become  whitened  or  thoroughly  dry,  then  throw  on  a  con- 
tinuous spray  of  ether.  A  jet  of  nitrous  oxide  gas  directed 
into  the  cavity  of  the  tooth  by  a  piece  of  tubing ;  also  the 
vapor  of  alcohol,  produced  by  heating  the  alcohol  in  a  metal 
apparatus,  and  conducting  the  vapor  into  the  cavity  through 
a  fine  metal  tube,  have  also  been  employed  for  the  relief  of  the 
pain  arising  from  hyper-sensitive  dentine.  The  application  of 
cocaine  and  alcohol  by  electrolysis  has  also  given  satisfactory 
results.     (See  Therapeutics  of  Electricity.) 

Abrasion  of  the  Teeth  is  indicated  by  a  loss  of  structure,  due 
to  friction,  to  such  an  extent  at  times  as  to  destroy  the  entire 
crowns. 

Treatment. —  Gold  caps  or  partial  crowns,  either  in  the  form 
of  ferrules  or  contour  fillings,  or  fillings  of  other  metals,  will 
often  arrest  the  process  of  abrasion,  and  render  much  worn 
teeth  useful  organs.  Also  the  insertion  of  artificial  posterior 
teeth  will  often  prevent  natural  front  teeth  from  being  abraded 
from  unnatural  use. 

Hypertrophy  of  the  Alveolar  Processes  is  indicated  by  an 
osseous  deposit,  either  at  the  apex  of  the  alveolar  cavity,  in 
which  case  the  affected  tooth  is  protruded  from  its  cavity,  or 
by  a  deposit  of  osseous  matter  on  the  wall  of  the  alveolar  cavity, 
in  which  case  the  tooth  is  forced  to  one  side. 

Treatment. — When  the  osseous  deposit  is  in  the  bottom  of 
the  alveolar  cavity,  the  length  of  the  tooth  may  be  reduced 
from  time  to  time  until  a  certain  degree  is  reached,  when  the 
loss  of  the  tooth  is  inevitable.  When  the  deposit  is  upon  the 
side  of  the  cavity,  the  effect  is  irregularity  or  malposition,  for 
which  there  is  often  no  remedy  but  the  removal  of  the  devi- 
ating tooth. 


DIAGNOSIS   OF  MOUTH   AFFECTIONS.  65 

Hypercementosis  or  Dental  Exostosis  is  indicated  by  an  uneasy 
sensation  in  the  affected  tooth,  followed  by  a  gnawing  pain, 
which  in  some  cases,  assumes  a  severe  neuralgic  character, 
especially  when  the  deposit  of  cementum  on  the  root  is  of 
considerable  size,  in  which  case  there  is  a  prominence  appar- 
ent on  the  side  of  the  alveolar  ridge. 

Treatntefit. — During  the  early  stages  of  this  affection,  the 
administration  of  large  doses  of  iodide  of  potassium,  and  the 
application  of  counter-irritants,  such  as  a  saturated  tincture  of 
iodine  or  cantharidal  collodion,  have  been  suggested,  to  arrest 
the  deposit  and  cause  absorption.  When  the  deposit  is  large 
and  productive  of  pain  and  inconvenience,  the  removal  of  the 
affected  tooth  is  inevitable. 

Organic  Defects  of  Structure,  indicated  by  defects  in  the 
enamel,  in  the  form  of  opaque  spots,  grooves  or  pits,  congenital 
in  origin,  and  due  to  altered  functions  from  impaired  nutrition. 

Treatment. — Preventive  by  mitigating  severity  of  diseases 
producing  the  condition,  by  the  administration  of  proper 
remedies.     For  the  pitting  variety,  properly  inserted  fillings. 

Odontomes  are  indicated  by  irregular  masses  of  dental  tis- 
sues, which  result  from  morbid  conditions  of  the  formative 
pulp,  such  as  nodules  of  enamel  and  dentine,  hypertrophy  of 
cementum,  etc.,  some  being  congenital,  others  induced. 

Treatment. — Extraction,  when  they  are  a  source  of  irritation, 
or  an  injury  to  the  normal  teeth,  or  are  unsightly. 

Syphilitic  Teeth  are  indicated  by  notches,  generally  crescentic, 
in  the  cutting  edges  of  the  incisors,  and  peg-like  shaped  cust 
pids ;  also,  a  dark  color  and  soft  consistence  are  characteristic 
of  such  teeth. 

Treatment. — The  most  skillful  treatment  by  properly  intro- 
duced fillings  and  constant  attention,  are  necessary  for  their 
preservation. 

Erosion  of  the  Teeth  is  indicated  by  the  gradual  destruction 
of  the  enamel  of  the  labial  surfaces  of  the  incisors,  canines,, 
and  sometimes  of  the  bicuspids,  generally  in  the  form  of  a 
continuous  horizontal  groove,  smooth  and  regular;,  in  some 
cases  it  may  extend  over  nearly  the  whole  of  the  labial,  surface, 
5 


66  DENTAL   MEDICINE. 


the  color  of  the  enamel  being  rarely  changed.  Erosion  is  the 
smooth  removal  of  the  surface  of  the  enamel,  a  smooth  sur- 
face remaining ;  corrosion  is  the  destruction  of  the  enamel  in 
the  form  of  pits  and  irregularities  due  to  an  acid  condition  of 
the  fluids  of  the  mouth,  lactic  acid  being  a  prominent  factor 
in  promoting  fermentative  action. 

Treatment. — In  advanced  stages,  arrest  its  progress  by  fill- 
ings of  durable  material. 

Absoi'-ption  of  Process  and  Recession  of  Gum  is  indicated  by 
a  slight  increase  of  redness,  some  congestion  and  a  shrinkage 
of  the  margins  of  the  gums,  and  may  be  accompanied  with  a 
slight  purulent  discharge  about  the  neck  of  the  affected  tooth. 
The  symptoms  resemble  those  of  chronic  inflammation  of  the 
gums.  The  progress  of  the  affection  is  generally  slow,  and  is 
often  first  observed  about  the  necks  of  the  canine  teeth.  Teeth 
so  aflected  become  more  susceptible  to  impressions  of  heat, 
cold,  acids,  etc.,  and  eventually  loose. 

Treatment. — To  arrest  the  progress  of  this  affection,  first 
remove  all  irritants,  and  cleanse  thoroughly,  polishing  the  ex- 
posed surfaces.  Correct  the  nature  of  the  fluids  of  the  mouth, 
if  at  fault,  by  constitutional  treatment,  the  use  of  alkahne 
lotions,  such,  as  lime  water,  and  detergent  dentifrices.  Such 
agents  as  a  weak  solution  of  chloride  of  zinc,  to  produce 
healthy  granulation,  carbolic  acid, nitrate  ofsilver, and  judicious 
pressure,  may  be  employed  with  advantage.  A  moderately 
stiff  brush  and  floss  silk  are  useful  adjuncts  to  the  treatment. 

Necrosed  Teeth. — The  term  "necrosed"  is  applied  to  a  tooth 
when  the  vitality  of  its  pulp  and  lining  membrane  is  destroyed, 
the  peridental  membrane,  however,  maintaining  a  degree  of 
vitality  which  prevents  the  tooth  from  becoming  an  irritant,  so 
as  to  insure  its  loss  as  an  effete  organ. 

Treatment. — When  a  necrosed  tooth  is  not  productive  of 
injury  to  the  adjacent  structures,  and  there  is  a  probability  of 
rendering  it  a  useful  organ,  the  pulp  canal  should  be  thoroughly 
exposed,  cleansed,  and  treated,  if  necessary,  with  disinfectants, 
antiseptics,  etc.,  and  then  filled,  together  with  the  crown  cavity, 
with  a  suitable  material     As  necrosed  teeth  are  frequently 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  67 

considerably  discolored,  on  account  of  the  tubuli  of  the  den- 
tine absorbing  coloring  matter  from  the  dead  pulp,  such 
bleaching  agents  as  chloride  of  lime,  chloride  of  alumina,  oxalic 
acid,  chloride  of  soda,  sulphite  of  soda  combined  with  boracic 
acid,  cyanide  of  potassium,  tartaric  acid  in  combination  with 
chloride  of  lime,  chloride  of  zinc,  also  alum  in  combination 
with  liq.  sodae  chlorinatae,  may  be  employed  to  improve  their 
appearance,  also  use  of  nitrous  oxide  in  combination  with 
chloride  of  sodium,  also  peroxide  of  hydrogen. 

Infantile  Paralysis  Diiring  the  Period  of  Teething. — Infantile 
paralysis,  or  poliomyelitis,  is  an  obscure  affection  peculiar 
to  a  certain  season,  which  has  given  to  it  at  the  hands  of  some 
the  name  of  "  warm  weather  spinal  disease."  It  comes  on 
suddenly,  but  seldom  after  the  age  of  four  years.  According 
to  Gowers,  of  all  cases  under  ten  years,  three-fifths  occur  in 
the  first  two  years  of  life,  and  he  claims  that  a  considerable 
number  of  cases  are  congenital.  There  is  usually  a  febrile  ini- 
tial stage  followed  by  the  sudden  onset  of  paralysis  in  one  leg 
or  arm.  In  more  than  half  the  cases  the  lower  limbs  are 
affected ;  of  the  remainder,  the  majority  represent  implications 
of  the  arms,  notably  the  deltoid  muscles,  and  legs,  or,  perhaps, 
arm  and  leg,  and  very  seldom  the  upper  extremity  alone. 
The  cause  of  infantile  paralysis  is  generally  assigned  to  teeth- 
ing, cold  or  damp,  injuries  to  the  spine,  measles,  scarlatina, 
malarial  or  other  fevers,  convulsions  or  concussion.  Dr.  Rot 
at  the  Fourth  Prussian  Congress,  declared  that  heredity  is  the 
only  etiological  factor  that  has  been  proven.  "  The  primary 
cause  of  the  affection  must  be  sought  for  in  the  modifications 
of  that  part  of  the  fecundated  ovum  which  enters  into  the 
formation  of  the  nervous  system."  During  the  period  of  denti- 
tion, children  are  liable  to  disorders  of  the  cerebro-spinal  sys- 
tem, and  as  from  such  causes  we  find  convulsions  the  cause  of 
the  death  of  numberless  infants  seemingly  robust,  so  we  see 
the  same  cause  producing  paralysis.  There  is  loss  of  heat 
and  atrophy  in  the  affected  limbs,  and  the  latter  may  be  a 
feature  of  the  disease  dependent  upon  the  morbid  changes  in 
the  nerve-centres.     The  atrophy  extends  to  the  bony  system, 


68  DENTAL   MEDICINE. 


the  nutrition  of  which  is  involved ;  and  it  is  evident  that  the 
atrophic  degeneration,  if  not  inherent,  is  a  real  sequence  of  in- 
flammatory process  in  the  spinal  cord. 

Treatment. — The  treatment  of  infantile  paralysis  consists  in 
the  application  of  mild  galvanic  stimulation  by  the  uninter- 
rupted current  conveyed  through  the  affected  cord  out  through 
the  nerves  of  the  flabby  muscles;  the  skin  may  also  be  stimu- 
lated with  salt  and  sulphur  baths.  In  the  early  stage  Dr. 
Althaus  advises  the  injection  of  ergotine  ^  gr.,  for  a  child  a 
year  old,  in  order  to  contract  the  arterioles  of  the  part  to  de- 
plete the  blood  supply.  He  stimulates  the  muscles  as  they 
become  affected  with  injections  of  strychnine.  Conium  and 
chloral  may  be  used  to  calm  nervous  excitement.  Dr.  Sequin 
recommends  counter-irritation  over  the  spine,  bromides  and 
arsenic,  while  others  use  cupping,  leeches,  and  iodide  of  po- 
tassium. Brown-Sequard  recommended  belladonna  to  control 
the  inflammatory  process  of  the  spinal  cord.  If  pain  or  fever 
are  present,  ether  spray  to  the  spine,  ice,  gelsemium,  aconite, 
antipyrine  internally.  Rubbing,  muscle-beating  and  massage, 
have  also  been  employed  as  adjuncts. 

Chemical  Bleaching  of  Teeth. — Prof  Truman's  method  con- 
sists in  liberating  chlorine  from  calcium,  hydrochlorite  or  chlo- 
ride of  lime,  in  the  cavity  of  decay  and  pulp  canal  by  a  dilute 
acid.  He  recommends  a  fifty  per  cent,  solution  of  acetic  acid, 
although  oxalic,  citric,  or  tartaric  acid  may  be  used,  or  indeed 
any  dilute  acid  to  liberate  the  chlorine.  The  upper  third  of 
the  pulp  canal  should  be  filled  with  gutta-percha,  and  the 
cavity  in  all  cases  should  be  washed  out  with  ammonia  or 
borax,  to  remove  the  fatty  matter,  previous  to  the  introduction 
of  the  bleaching  agent.  Labarraque's  solution  of  soda  has  also 
been  used  as  a  medium  from  which  to  liberate  the  chlorine. 
Dr.  A.  W.  Harlan  uses  aluminum  chloride  in  the  cavity,  from 
which  he  liberates  the  chlorine  by  means  of  peroxide  of  hy- 
drogen. Dr.  Edw.  C.  Kirk's  method  consists  of  liberating 
sulphurous  acid,  SO2,  from  sodium  sulphite,  NagSOs,  by 
means  ofboracic  acid.  The  two  substances,  in  the  proportion 
of  100  grains  of  sodium  sulphite  and  70  grains  ofboracic  acid, 


DIAGNOSIS   OF  MOUTH   AFFECTIONS.  69 

are  desiccated  separately,  and  then  intimately  ground  together 
in  a  warm  dry  mortar.  In  using  this  powder,  the  tooth  is 
carefully  dried  under  the  dam,  and  the  powder  is  packed  into 
the  pulp-cavity  and  cavity  until  both  are  full ;  the  reaction  which 
hberates  the  sulphurous  acid  is  then  brought  about  by  moist- 
ening the  powder  in  the  tooth  with  a  drop  of  water,  and  the  ori- 
fice of  the  cavity  is  immediately  closed  with  warm  gutta  percha. 

Herpes  Zoster  of  Mouth  and  Gums. — An  acute  circumscribed 
inflammatory  affection,  characterized  by  an  eruption  of  vesicles 
of  herpes  on  a  red,  inflamed  basis,  the  vesicles  being  disposed 
in  groups  and  follow  the  group  of  the  adjacent  nerve.  The 
eruption  is  preceded  and  accompanied  by  a  very  severe  neu- 
ralgia of  the  fifth  nerve.  The  period  of  invasion  (three  days) 
is  accompanied  by  a  well-defined  fever  and  other  general 
symptoms.  The  period  of  eruption  begins  on  the  third  day, 
and  lasts  about  three  weeks  to  one  month,  the  pain  being  per- 
sistent. It  is  probably  of  an  infectious  origin,  and  is  due  to  a 
neuritis  of  the  affected  region  which  leads  to  trophic  changes. 

Treatment. — Dr.  Harlan  recommends  a  palliative  treatment, 
which  consists  of  placing  cotton-wool  between  the  cheek  and 
teeth  to  prevent  friction,  and  on  it  an  ointment  consisting  of 
cocaine  and  morphine. 

Merck's  Bulletin  gives  the  following  new  treatment  for 
herpes  zoster : 

MIXTURE. 

R .     Extract  gelsemium,  1    ^       ,    . 

^  °  '  V  of  each  4  grammes. 

Sodium  sulpho-carbolate,  J 

Distilled  water 90  grammes. 

M.  Sig.     One  teaspoonful  every  two  hours. 

At  the  same  time  five  drops  tincture  of  belladonna  are  ad- 
ministered every  two  hours  until  a  slight  dryness  of  the  pharynx 
is  experienced. 

LOTION. 

R .     Lead  acetate,        "I     ,-       , 

„       ,       ,    ,  >  of  each  4  grammes. 

I'owdered  alum,  J 

Distilled  water,  .    .    .    .120  grammes. 

M.  Sig.     Externally. 

Compresses  moistened  with  this  solution  are  applied  to  the 


70  DENTAL   MEDICINE. 


affected  parts,  and  renewed  every  two  hours.  It  is  claimed 
that  the  pain" disappears  within  a  few  hours,  and  that  the  dis- 
ease is  considerably  shortened  by  this  treatment. 

De7ital  Caries  is  indicated  by  a  process  of  gradual  softening 
and  disintegration  of  the  tooth  tissues  by  deleterious  agents, 
the  progress  being  hastened,  primarily,  by  certain  structural 
defects  in  the  enamel  and  dentine,  and  secondarily,  by  certain 
diseases  of  the  mucous  membrane,  and  some  derangement  of 
the  general  health.  Incipient  dental  caries  is  indicated  by  an 
opaque,  whitish  or  gray  appearance  of  the  enamel.  A  pale 
brown  varying  to  a  nearly  black  color  indicates  the  existence 
and  progress  of  dental  caries  in  the  tooth  tissues ;  the  deeper 
the  color  the  slower  the  progress  of  the  caries,  and  the  paler 
the  color  the  more  rapid  the  progress.  The  softening  and  de- 
calcifying of  the  bones,  and  the  proneness  of  the  teeth  to 
caries  during  pregnancy,  is  ascribed  to  faulty  nutrition  and  the 
lack  of  the  supply  of  the  proper  elements  to  the  system,  and 
the  waste  going  on  during  this  period.  But  the  principal  ex- 
citing cause  of  caries  of  the  teeth  during  pregnancy  is  the 
lactic  acid  fermentation  present,  its  action  being  greatly  aug- 
mented by  the  changed  condition  of  the  fluids  of  the  mouth, 
such  acids  existing  in  the  secretions  of  the  mouth  as  hydro- 
chloric, acetic,  oxalic  and  uric. 

Treatment. — Incipient  caries  should  be  removed  with  great 
care,  and  the  exposed  surface  of  tooth  structure  prepared  to 
resist  further  attacks  by  giving  to  it  as  high  a  polish  as  is  pos- 
sible, and  the  patient  warned  in  regard  to  its  future  cleanli- 
ness. Deep-seated  caries  should  be  removed,  and  its  further 
progress  arrested  by  thoroughly  sterilizing  or  disinfecting  the 
cavity  by  antiseptics  and  disinfectants,  and  the  careful  insertion 
of  fillings  of  a  durable  material.  During  pregnancy  all  oper- 
ations on  the  teeth  should  be  painless,  and  long,  wearying  sit- 
tings be  avoided.  Caries  of  the  teeth  of  pregnant  women  can 
be  arrested  by  plastic  fillings  until  such  time  as  the  patient 
can  the  better  endure  more  permanent  operations.  The  pre- 
ventive measures  consist  in  the  thorough  and  frequent. use  of 
the  tooth-brush  and  its  adjunct,  floss  silk,  at  least  three  times 
a  day,  assisted  by  a  proper  dentifrice  and  antacid  mouth-wash. 


DIGESTIBILITY   OF   FOODS.  71 


CHARACTERISTIC   INDICATIONS   OF   THE   TONGUE. 

A  White  Coated  To7igiie  indicates  febrile  disturbance. 

A  Brown  Moist  Tongue  indicates  digestive  disorder  and  an 
overloaded  stomach. 

A  Brown  Dry  Tongue  indicates  depressed  vital  power. 

A  Red  Moist  Tongue  indicates  feebleness,  especially  from 
exhaustive  discharges. 

A  Red  Dry  Tongue  indicates  inflammatory  fever  or  pyrexia. 

A  Red  Glazed  Tongue  indicates  debility  and  inability  to  di- 
gest food  and  stimulants. 

A  Treniulous,  Moist  and  Flabby  Tongue  indicates  feebleness 
and  nervousness. 

A  Glased  Bluish  Tongue,  with  loss  of  epithelium  in  patches, 
and  in  severe  cases,  cracks  and  scars,  indicates  tertiary  syphilis. 

DIGESTIBILITY   OF   FOODS. 

Giving  the  time  required  for  the  digestion  in  the  stomach  of 
various  alimentary  substances,  derived  from  actual  experi- 
ments. 

Article.                                                           Mode  of  Prep.                         Hrs.  Min. 

Aponeurosis  (gristle) Boiled, 3  00 

Apples,  sour,  mellow Raw 2  00 

Apples,  sour,  hard Raw 2  50 

Apples,  sweet,  mellow Raw I  30 

Bass,  striped  . Broiled 3  00 

Beans,  pod Boiled 2  30 

Beans  and  green  corn Boiled 3  45 

Beef Fried 4  00 

Beefsteak Broiled 3  00 

Beef,  fresh,  lean,  dry Roasted 3  30 

Beef,  fresh,  lean,  rare Roasted 3  00 

Beef,  with  mustard,  &c Boiled 3  10 

Beef,  with  salt  only Boiled 3  36 

Beets Boiled 3  45 

Brains,  animal .    .  Boiled i  45 

Bread,  corn Baked 3  15 

Bread,  wheat,  fresh Baked 3  30 

Cabbage Raw 2  30 

Cabbage  with  vinegar Raw 2  00 


72  DENTAL   MEDICINE. 


Article.                                                                    Mode  of  Prep.                     Hrs.  Min. 

Cabbage Boiled 4  30 

Carrot,  orange  .    .^ Boiled 3  13 

Cartilage Boiled 4  15 

Catfish •    • Fried 3  30 

Cheese,  old  and  strong Raw 3  30 

Chicken,  full-grown Fricaseed 2  45 

Codfish,  cured,  dry Boiled 2  00 

Custard Baked 2  45 

Duck,  tame Roasted 4  00 

Duck,  wild Roasted 4  30 

Eggs,  fresh Raw 2  00 

Eggs,  fresh Whipped I  30 

Eggs,  fresh Roasted 2  15 

Eggs,  fresh Soft  Boiled, 3  00 

Eggs,  fresh Hard  boiled        ....  3  30 

Eggs,  fresh Fried 3  30 

Fowls,  domestic Roasted 4  00 

Fowls,  domestic Boiled 4  00 

Gelatine Boiled 2  30 

Goose,  wild  . Roasted 2  30 

Hashed  meat  and  vegetables Warmed 2  30 

Heart,  animal Fried 4  00 

Lamb,  fresh Broiled 2  30 

Liver,  beeves',  fresh Broiled 2  00 

Marrow,  spinal,  animal Boiled 2  40 

Milk Boiled 2  00 

Milk Raw 2  15 

Mutton,  fresh Broiled 3  00 

Mutton,  fresh Boiled 3  00 

Mutton,  fresh Roasted 3  15 

Oysters,  fresh Raw 2  55 

Oysters,  fresh Roasted 3  15 

Oysters,  fresh Stewed 3  30 

Parsnips Boiled 2  30 

Pig,  Sucking, Roasted 2  30 

Pig's  feet,  soused Boiled i  00 

Porksteak Broiled 3  15 

Pork,  fat  and  lean Roasted 5  15 

Pork,  recently  salted Stewed 3  00 

Pork,  recently  salted Broiled 3  15 

Pork,  recently  salted Fried 4  15 

Pork,  recently  salted Boiled 4  30 

Potatoes,  Irish Roasted 2  30 

Potatoes,  Irish Baked 2  30 

Potatoes,  Irish Boiled 3  30 


ABBREVIATIONS   FOR   PRESCRIPTIONS. 


73 


Articlb.  Mode  of  Prep.  Hrs. 

Salmon,  salted Boiled 4 

Sausage,  fresh Broiled 3 

Soup,  barley Boiled I 

Soup,  bean Boiled 3 

Soup,  chicken Boiled 3 

Soup,  mutton Boiled 3 

Soup,  oyster Boiled 3 

Soup,  beef,  vegetables  and  bread Boiled 4 

Soup,   marrow  bones Boiled 4 

Tripe,  soused Boiled i 

Trout,  Salmon,  fresh Boiled I 

Trout,  Salmon,  fresh Fried i 

Turkey,  wild Roasted 2 

Turkey,  domesticated Roasted 2 

Turkey,  domesticated  Boiled 2 

Turnips Boiled 3 

Veal,  fresh Boiled 4 

Veal,  fresh Fried 4 

Venison  steaks Broiled i 


MiN. 

00 
20 

30 

CO 
00 
30 
50 

00 

IS 
00 

30 
30 
18 

30 
25 
30 
00 

30 
35 


ABBREVIATIONS. 
In  medical  prescriptions,  letters,  parts  of  words,  or  certain 
symbols,  are  employed  as  abbreviations,  to  designate  the  sub- 
stance, quantity,  etc.,  as  follows : — 


ABBREVIATION. 

LATIN   WORD. 

ENGLISH   WORD. 

aa, 

Ana  (G.), 

Of  each. 

Ad  Saturand., 

Ad  saturandum, 

Until  saturated. 

Ad  lib., 

Ad  libitum, 

At  pleasure. 

Aq., 

Aqua, 

Water. 

Aq.  tepid., 

Aqua  tepida. 

Warm  water. 

Aq.  ferv., 

Aqua  fervens. 

Hot  water. 

Aq.  dest.. 

Aqua  destillata, 

Distilled  water. 

C.  or  Cong., 

Congius, 

A  gallon. 

Chart., 

Chartula, 

A  small  paper. 

Coch., 

Cochlear, 

A  spoonful. 

Coch.  mag., 

Cochlear  magnum, 

A  tablespoon  ful. 

Coch.  parv.. 

Cochlear  parvum. 

A  teaspoonful. 

Colent., 

Colentur, 

Let  them  be  strained. 

Collyr., 

Collyrium, 

An  eye-water. 

Comp., 

Compositus, 

Compound. 

Contus., 

Contusus, 

Bruised  or  broken. 

Cort., 

Cortex, 

Bark. 

Ext., 

Extractum, 

An  extract. 

F.  or  Ft., 

Fiat  vel  fiant, 

Let  there  be  made. 

74 


DENTAL   MEDICINE. 


ABBREVIATION. 

LATIN   WORD. 

ENGLISH    WORD. 

Fol., 

Folium  vel  folia, 

A  leaf  or  leaves. 

Garg., 

Gargarysma, 

A  gargle. 

Gr., 

Granum  vel  grana. 

A  grain  or  grains. 

Gtt., 

Gutta  vel  guttse. 

A  drop  or  drops. 

Haust., 

Haustus, 

A  draught. 

Infus., 

Infusum, 

An  infusion. 

M., 

Misce, 

Mix. 

Mass., 

Massa, 

A  mass. 

Mist., 

Mistura, 

A  mixture. 

0., 

Octarius, 

A  pint. 

Pil., 

Pilula  vel  pilulse, 

A  pill  or  pills. 

Pulv., 

Pulvis  vel  pulveres, 

A  powder  or  powders. 

q.  s., 

Quantum  sufficit, 

A  sufficient  quantity. 

R., 

Recipe, 

Take. 

Rad., 

Radix, 

A  root. 

S., 

Signa, 

Write  or  give  directions. 

Spts., 

Spiritus, 

Spirits. 

ss., 

Semis, 

The  half. 

Syr., 

Syrupus, 

Syrup. 

Tinct., 

Tinctura, 

A  tincture. 

m., 

Libra, 

A  pound. 

g, 

Uncia, 

An  ounce. 

5. 

Drachma, 

A  drachm. 

.9. 

Scrupulus, 

A  scruple. 

fg, 

Fluiduncia, 

A  fluid  ounce. 

f5. 

Fluidrachma, 

A  fluid  drachm. 

m. 

Minim, 

A  drop. 

Although  the  symbol  (ITL)  is  adopted  in  the  United  States 
Pharmacopoeia  to  designate  a  drop,  it  should  be  remembered 
that  the  size  of  a  drop  varies  according  to  the  greater  or  less 
fluidity  and  gravity  of  the  liquid,  and  the  shape  of  the  mouth 
of  the  bottle  from  which  it  is  dropped.  It  is  best  to  use  a 
small  vial  with  a  thin  edge  of  mouth,  when  great  precision  is 
necessary,  and  to  dilute  the  active  medicine  and  administer  it 
in  the  form  of  a  mixture ;  for  in  some  preparations,  one  hun- 
dred and  fifty  drops  would  measure  but  a  fluidrachm,  while  in 
others  the  same  number  of  drops  would  be  somewhat  more 
than  three  fluidrachms. 

A  tablespoonfid  of  any  liquid  is  regarded  as  equal  to  half  an 
ounce  by  measure;  and  a  teaspoo7iful  equal  to  2.  fluidrachm ; 


FINENESS   OF   POWDER.  75 

and  such  measures  are  sufficiently  accurate  where  no  great 
precision  is  requisite. 

A  gallon  contains  eight  pints. 

A  pirjt  contains  sixteen  fluidounces. 

A  fluid  ounce  contains  eight  fluidrachms. 

A  fluidrachm  contains  sixty  minims  (TTt). 

A  wine  glass  (approximate  measurement)  contains  two  fluid- 
ounces. 

A  teacup  (approximate  measurement)  contains  four  fluid- 
ounces. 

A  tablespoon  of  powder  (approximate  measurement)  con- 
tains two  drachms. 

A  teaspoon  of  powder  (approximate  measurement)  contains 
one-half  drachm. 

One  drop  of  water  (small  drop,  approximate  measurement) 
contains  one  minim. 

One  drop  of  essential  oils  (approximate  measurement)  con- 
tains one-half  minim. 

A  graduated  measure  glass  is  the  most  accurate  measure, 
as  spoons,  glasses,  etc.,  vary  greatly  in  size. 

FINENESS   OF   POWDER. 

The  fineness  of  powder  is  denoted  either  by  descriptive 
words  (as  in  the  case  of  brittle  and  easily  pulverizable  sub- 
stances), or  in  terms  expressing  the  number  of  meshes  to  a 
linear  inch  in  the  sieve.  The  following  degrees  of  fineness 
will  prove  serviceable  in  the  preparation  of  dentifrices,  polish- 
ing powders,  etc. : — 

("Should  pass  through  a  I 

A  very  fifie  powder  .    .    .  vievehaving8oormoreV  =  No.  80  Powder. 

^  (meshes  to  linear  inch.    J 

("Should  pass  through  a~| 

A    fine    powder ^  sieve  having  60  meshes  V  =  No.  60   PowdCf. 

(      'o  the  linear  inch.       J 

("Should  pass  through  a)         -  -  t->  i 

A  moderately  fine  powder    \  sieve  having  50  meshes  \  =  No.  ^o  Powder. 

"'  ^  (       to  the  linear  inch.      )  •' 

f.  J  1  1        ("Should  pass  through  a") 

A  moderately  coarse  powders  sieve  having  40  meshes  \  =  No.  40  Powder. 

(.to  'he  linear  inch.      ) 
.  (Should  pass  through  a") 

A  coarse  powder  ....  ^  sieve  having  20  meshes  ^  =  No.  20  Powder. 

(,      to  the  linear  inch.       ) 


76  DENTAL   MEDICINE. 


WEIGHTS  AND  MEASURES. 
APOTHECARIES'  WEIGHT. 

20  grains  (gr.)  make  I  scruple sc.  or  ^ 

3  scruples         make  I  drachm dr.  or  ^^^ 

8  drachms        make  i  ounce •  oz.  or  ^ 

12  ounces  make  I  pound lb.    or  lb 

SCALE  OF  COMPARISON. 

R)                            oz.                            dr.  sc.  gr. 

I             =             12            ^             96  =  288  =  5760 

I             =               8  =  24  ^  480 

I  =  3  =  60 

I  ^  20 

TROY  WEIGHT. 

24  grains  (gr.)      make  I  pennyweight dwt. 

20  pennyweights  make  I  ounce oz. 

12  ounces  make  i  pound R). 

Z}2  grains  make  i  carat  (diamond  weight) k. 

SCALE   OF   COMPARISON. 

R).  oz.  dwt.  gr. 

I  ^  12  ==  240  =  5760 

I  =  20  ^  480 

I  ^  24 

I  k.         =  zyi 

AVOIRDUPOIS  WEIGHT. 

16  drachms  (dr.)    make  I  ounce oz, 

16  ounces  make  I  pound lb. 

25  pounds  make  i  quarter qr. 

4  quarters  make  I  hundred  weight cwt. 

20  hundredweight  make  I  ton T. 

ICO  pounds  make  i  central C. 

SCALE  OF  COMPARISON. 

T.      cwt.      qr.       R).         oz.         dr. 
I   =   20   =   So   =   2000   =   32000   =   512000 
I   =   4   =    100   =r    4000   =    25600 

I    =      25    =      400    =:      6400 

I   =     16   =     256 

I    =  16 

THE  METRIC  OR  FRENCH  DECIMAL  SYSTEM  OF  WEIGHTS  AND 
MEASURES. 

The  metric  system  is  based  upon  the  meter,  which  is  the 
Standard  unit  oi  length  of  that  system,  and  equal  to  39.370432 
inches,  or  about  10  per  cent,  longer  than  the  yard. 

The  metric  unit  oi  fluid  measure  is   the  liter — the  cube  of 


WEIGHTS   AND   MEASURES.  77 

iV  meter,  or  looo  cubic-centimeters — equal  to  about  34  fluid 
ounces. 

The  metric  unit  of  weight  is  the  gram,  which  represents 
the  weight  of  one  cubic-centimeter  of  water  as  its  maximum 
density.     It  is  equal  to  I5(.43234874)  troy  grains. 

One  CUBIC-CENTIMETER  is  equal  to  16,231  minims. 

In  writing  prescriptions  it  is  sufficiently  accurate 
and  safe  to  consider  i  gram  as  exactly  equal  to  i  5  troy 
grains,  and  to  consider  i  cubic-centimeter  as  equal  to  i  5 

MINIMS. 

We  accordingly  have — 

I  gram  equal  ^-  troy  grains. 

I  troy  grain  equal  to  -^  gram. 

I  cubic-centimeter  equal  to  4"  fluidrachm. 

I  fluidrachm  equal  to  y  cubic-centimeter. 
Hence — 

1.  To  CONVERT  TROY  GRAINS  INTO  GRAMS,  OR  MINIMS  INTO 
CUBIC-CENTIMETERS — 

a.  Divide  by  10,  and  from  the  quotient  subtract  one-third; 
or,  b.  Divide  by  i^ ;   and 

2.  To  CONVERT  apothecaries'  DRACHMS  INTO  GRAMS,  OR 
FLUIDRACHMS    INTO  CUBIC-CENTIMETERS,  IHldtiply  by  4. 

In  writing  prescriptions,  the  "gram"  (abbreviated  "Gm.") 
and  "cubic-centimeter"  (abbreviated  "C.C,"  which  may  be 
called  "fluigram,"  and  written  "fGm")  only,  should  be  used. 

The  centigram,  which  is  a  very  convenient  unit  to  refer  to 
in  medicine  and  pharmacy,  is  used  in  books  and  in  speaking, 
but  not  in  writing  prescriptions. 

All  other  terms,  and  units,  and  prefixes,  used  in  the  metric 
system,  may  be  wholly  ignored  by  the  physician  and  the 
pharmacist.* 

♦"^he  prefixes  are  simply  numerals,  as  follows  : — 


deci,  which  means  o.l. 
centi,     "         "        0.0 1. 
mitU,    "         "       o.ooi. 


myria,  which  means  10,000. 

kilo,  "  "         1,000. 

Aecto,        "  "  100. 

deka,        "  "  10. 

and  are  quite  unnecessary  in  the  writing  of  prescriptions  (if  not   in  all   cases), 
English  numerals  being  more  convenient,  and  at  least  equally  explicit. 


78  DENTAL   MEDICINE. 


EXAMPLE   OF   A   METRIC   PRESCRIPTION. 

R.     Hydrarg.  chloridi.  corros .  o 

Potassi  iodidi lo 

Aquae lOO 

Tinct.  cinch,  comp loo 

Mix. 


25  Gm. 
00  Gm. 
00  C.C. 
00  C.C. 


The  use  of  a  decimal  line  prevents  possible  errors. 

To  write  a  prescription  for  fifteen  doses  of  any  medicine, 
write  it  first  for  one  dose  in  grains  and  minims,  and  then 
substitute  the  same  number  of  "grams"  and  "cube-cents," 
thus  : — 

H.     Opii gr.  j 

Camphoras gJ"-  y 

Make  one  pill. 

and  to  get  fifteen  such  doses  in  metric  terms,  write — 

R.     Opii I  Gm. 

Camphorse 2  Gm. 

Make  fifteen  pills. 

The  gram  and  the  cubic-centimeter  {Jlidgram),  when  refer- 
ring to  liquids,  may  be  considered  as  equal  quantities,  except 
the  liquids  be  very  heavy  (as  in  the  case  of  chloroform),  or 
very  light  (as  in  the  case  of  ether). 

Measures  may  be  discarded  and  weights  exclusively  em- 
ployed, if  preferred.  All  quantities  in  a  prescription  would 
then  be  expressed  in  grams.* 

The  average  "drop"  (water)  may  be  considered  equal  to 
0.05    C.C,  or  0.05  Gm.     An  average  teaspoon  holds  5    C.C. 

*As  any  liquid  medicine  must  necessarily  be  administered  to  the  patient  in 
measured,  and  not  in  weighed,  doses,  it  will,  of  course,  be  more  convenient  to 
the  physician  to  continue  to  make  use  of  fluid  measures  in  writing  prescriptions, 
especially  as  he  is  already  accustomed  to  this,  and  would  not  then  have  to  bear 
in  mind  the  specific  gravity  of  any  liquid  ingredient  in  the  prescription.  To  the 
pharmacist  it  makes  but  little  difference,  as  he  will  have  both  weights  and  meas- 
ures, and  can  use  one  or  the  other,  as  may  be  directed.  If  the  physician  discards 
measures,  he  must,  of  necessity,  so  adjust  the  proportion  in  his  formula  as  to  pro- 
duce a  mixture  of  which,  after  all,  the  dose  must  be  a  "teaspoonful,"  or  some 
other  convenient  measure,  and  this  is  as  unnecessary  as  it  is  difficult. —  Oscar 
Oldherg,  Phar.  D.,  in  Blakiston's  Phys.  Visiting  List. 


WEIGHTS   AND   MEASURES. 


79 


and  an  average  tablespoon  20  C.C.  Decimal  numbers 
should  be  used  as  far  as  practicable  without  sacrifice  of  ac- 
curacy as  to  strength  and  dose  of  the  preparation.  It  is  safe 
to  prescribe  30  Gin.  for  one  troy  ounce,  and  250  C.C.  for  eight 
fluidounces. 

The  above  contains  all  that  is  necessary  to  know  or 
LEARN  of  the  metric  system,  in  order  to  write  metric  pre- 
scriptions, without  a  metric  posological  table,  or  with  one. 

To  become  familiar  with  the  system,  the  rules  given  above 
for  the  conversion  of  apothecaries'  weights  and  measures  into 
the  corresponding  metric  quantities,  may  be  profitably  used, 
the  results  to  be  verified  by  comparison  with  the  following — 


TABLE  OF   equivalents. 


apothecaries  weights 
(and  measures). 

Troy  grains  {or  tiiznims). 

1 
6¥ 

1 
SI 

1 
T^ 

I 

2 

5 
10 

15 
20 

30 

Drachms  (or  JIuidrachms). 
I 

2 

4 

6 

Troy  ounces  {or  fluidounces). 

I 

2 

4 

6 

8 

12 
16 


METRIC 

WEIGHTS 

(and  measures). 

Grams  {or  cubic-centivteters) 

0.00 1 

(toVt ) 

0.002 

(xTS^Ty) 

0.004 

(xTJffo) 

0.008 

(too¥/ 

0.016 

(.V) 

0.033 

(s'o) 

0.066 

(tV) 

0-I33 

(ft) 

0.333 

a) 

0.666 

(t) 

1. 000 

(0 

^■i>y:> 

(li) 

2.000 

(2) 

Grams  {or  cubic-centimeters.) 

4 

8 

16 

24 

32 

64 

128 

192 

256 

384 

512 

The  adoption  of  the  metric  system  of  weights  and  measures 


80  DENTAL   MEDICINE. 


is  a  matter  of  time  only.     Its  advantages  over  other  systems 
are  well  recognized. 

RULES   FOR  REGULATING   DOSES. 

The  doses  given  in  this  work  are  applicable  to  adult  age 
unless  the  contrary  is  specified;  and  for  the  convenience  of 
students,  the  rules  of  Gaubins  and  Young  for  determining  the 
proper  dose  of  medicines  for  children  are  furnished  below. 

Take  the  dose  for  an  adult  as  unity,  and  for  other  ages  as 
follows : — 

The  dose  for  a  person  of  middle  age  being  I,  or  i  drachm, — 

That  for  a  person  from  14  to  21  years  will  be  %,  or     2  scruples. 


« 

7 

to 

14     " 

'     /^>  or  ^  a  drachm. 

(( 

4 

to 

7     " 

^,  or    I  scruple. 

a  child  of 

4     " 

X,  or  15  grains. 

« 

3     " 

i/^,  or  10  grains. 

« 

2    «            ' 

y%,ox    8  grains. 

(( 

I  year          ' 

T2'  ^^    S  grains. 

The  following  simple  rule  by  Dr.  Young  will  be  found  to  be 
convenient :  "  For  children  under  twelve  years,  the  doses  of 
most  medicines  must  be  diminished  in  the  proportion  of  the 
age  to  the  age  increased  by  1 2 ;  thus,  at  two  years  to  \ ;  viz. : 

?^ =  i.     At   twenty-one    the   full    dose   may  be   given." 

Hence 

For  one  year, 
For  two  years, 
For  three  years. 
For  four  years. 
For  six  years. 

At  twelve  years  the  dose  is  one-half  that  of  the  adult.  The 
U.  S.  Dispensatory  states  that  "  To  the  above  rules  some  excep- 
tions are  offered,  in  particular  medicines,  which  require  to  be 
given  to  children  in  much  larger  proportional  doses  than  those 


I 

= 

I 

1  + 

2 

12 

13 

I 

2  + 

3 

12 

7 
I 

3  + 
4 

12 

5 
I 

4  + 
6 

12 

4 
I 

6  + 

12 

3 

RULES   FOR   REGULATING   DOSES.  81 

above  stated.  Such  are  castor  oil  and  calomel,  a  certain 
quantity  of  which  will,  in  general,  not  produce  a  greater  effect 
in  a  child  two  or  three  years  old  than  double  the  quantity  in 
an  adult."  "  Females  usually  require  smaller  doses  than  males, 
and  persons  of  sanguine  temperament  than  the  phlegmatic." 
The  influence  of  constitutional  peculiarities,  such  as  are  known 
as  idiosyncrasies,  often  exist  and  render  patients  more  than 
usually  susceptible,  or  the  opposite,  to  the  action  of  medicines, 
the  doses  of  which  must  be  regulated  accordingly.  It  should 
also  be  remembered  that  the  susceptibility  to  the  action  of 
medicines  is  diminished  by  frequent  and  continued  use.  In 
advancing  age,  the  dose  is  gradually  lessened. 

Opiates  affect  children  to  a  greater  degree  than  adults,  but 
children  bear  larger  doses  of  calomel  than  adults.  Females 
are  more  rapidly  affected  by  purgatives  than  males,  and  the 
condition  of  the  uterine  system  is  very  important. 

Medicinal  substances  act  differently  on  the  same  person  in 
summer  and  in  winter,  and  in  different  climates.  Narcotics 
act  more  energetically  in  hot  than  in  cold  climates,  and,  as  a 
consequence,  smaller  doses  are  required  in  hot  climates ;  the 
opposite  is  the  case  with  regard  to  calomel.  Owing  to  a  pecu- 
liarity of  stomach,  or  rather  disposition  of  body,  unconnected 
with  temperament,  comparatively  mild  remedies  operate  very 
violently  on  some  individuals. 

When  administering  remedies,  the  intervals  between  the 
doses  should  be  so  regulated  that  the  second  dose  may  be 
taken  before  the  effect  produced  by  the  first  is  entirely  effaced. 
Some  medicinal  substances,  such  as  mercurial  salts,  arsenic, 
etc.,  are  prone  to  accumulate  in  the  system;  and  dangerous 
.symptoms  may  arise  if  the  doses  rapidly  succeed  one  another. 

The  action  of  some  remedies,  such  as  digitalis,  elaterium, 
etc.,  may  continue  long  after  the  discontinuance  of  the  3gent, 
and  a  too  powerful  effect  occur,  even  by  a  repetition  in  dimin- 
ished doses.  Some  remedies,  such  as  castor  oil,  aloes,  etc., 
acquire  activity  by  continued  use,  hence  the  dose  requires  to 
be  diminished. 


82  DENTAL   MEDICINE. 


TOPICAL   REMEDIES. 

Medicinal  substances  are  applied  to  the  mucous  membrane 
of  the  mouth  and  to  the  dental  structures  almost  exclusively 
for  local  effects.  In  dental  practice  antiseptic  remedies  are 
extensively  employed  to  arrest  fermentative  and  putrefactive 
processes,  as  every  kind  of  fermentation  depends  upon  the 
growth  and  increase  of  a  living  organism.  Various  diseases 
of  the  dental  structures  have  a  close  relationship  with  low 
organisms  in  the  morbid  processes  which  result  during  their 
progress,  and  which  are  maintained  and  developed  by  the 
presence  of  living  matter.  The  remedies  recognized  as  be- 
longing to  the  group  of  antiseptics,  when  brought  into  con- 
tact with  the  disease  germs,  which  are  constituted  of  these 
organized  forms  of  life,  have  the  power  of  destroying  their 
vitality  and  of  arresting  the  fermentative  or  putrefactive  pro- 
cess which  they  either  develop  or  promote.  The  effect  of 
escharotics  when  applied  to  a  part  of  which  the  structure  and 
vitality  are  to  be  destroyed,  is  to  produce  an  eschar  and  incite 
inflammation  and  suppuration  of  the  adjacent  tissues,  by  which 
the  slough  is  separated  from  the  living  parts. 

Medicinal  substances  are  applied  to  the  mucous  membrane 
of  the  mouth  in  the  form  of  gargles  or  mouth  washes,  lotions 
and  injections,  and  generally  for  a  local  effect. 

Medicinal  substances  are  applied  to  the  skin  for  both  a  local 
and  general  effect,  either  by  friction,  by  the  endermic,  or  by 
the  hypodermic  methods.  In  the  endermic  method,  the  cuticle 
is  usually  removed  by  the  action  of  a  blister,  and  the  medicinal 
agent  is  applied  to  the  denuded  surface  in  the  form  of  a  powder 
or  ointment,  and  is  a  useful  method  when  the  irritability  of  the 
stomach  or  difficult  deglutition  prevents  medicines  from  being 
taken  through  the  mouth. 

The  hypodermic  method  consists  in  injecting  medicines  by 
means  of  a  graduated  syringe  with  a  sharp-pointed  nozzle,  and 
constructed  for  the  purpose,  into  a  subcutaneous  cellular 
tissue,  thus  producing  both  a  local  and  general  effect,  and  an 
impression  is  made  much  more  rapidly  than  when  the  medicine 


TOPICAL   REMEDIES.  S3 


is  taken  into  the  stomach.  It  is  necessary  that  the  remedy- 
should  be  appHed  beneath  the  skin,  and  that  it  should  not  be 
injected  into  any  large  vessel ;  hence  for  hypodermic  injections 
a  locality  should  be  selected  free  from  nerves  and  large  ves- 
sels. The  medicinal  agents  used  for  hypodermic  injections 
are  now  prepared  in  the  form  of  tablets  which  are  perfectly 
soluble,  and  of  considerable  strength  in  small  bulk.  They  are 
dissolved  in  pure  water  at  the  time  the  injection  is  to  be 
made  and  great  accuracy  is  thus  obtained.  Anodynes  thus 
used  are  more  rapid  in  their  effect,  and  the  general  rule  as  re- 
gards the  quantity  is,  that  in  first  injections  the  dose  should 
be,  for  males,  two  thirds  of  the  ordinary  dose  by  the  stomach 
and  for  females,  about  one-half  It  is  very  necessary  that  a 
vein  or  large  vessel  should  not  be  punctured  when  introducing 
the  point  of  the  syringe.  The  insertion  of  the  deltoid  muscle 
in  the  arm  is  generally  selected  as  the  place  of  injection,  and 
the  needle-point  of  the  syringe  should  not  be  inserted  too  deep 
nor  at  the  same  point  in  subsequent  injections.  Hypodermic 
injections  may  also  be  made  in  the  back,  front  or  thigh — ^just 
in  front  of  trochanters,  and  in  the  calf  of  the  leg. 

Medicinal  substances  of  the  classes  of  rubefacients  and 
epispastics  are  employed  as  counter-irritants,  their  effect  being 
to  establish  external  or  artificial  irritation  for  the  relief  or  cure 
of  internal  inflammation  existing  in  a  part  or  in  the  body. 
The  extent  and  character  of  the  counter-irritation  thus  es- 
tablished should  be,  in  a  great  measure,  regulated  by  the 
character  of  the  disease  which  it  is  intended  to  relieve  ;  a 
rubefacient  being  indicated  in  irritation  of  mucous  membrane, 
a  seton  or  issue  when  the  disease  is  of  a  suppurative  character, 
and  a  vesicant  in  inflammation  of  serous  membranes. 

Setons  and  Issues  are  employed  to  produce  permanent 
counter-irritant  effects.  A  seton  consists  of  a  skein  of  silk  or 
a  piece  of  tape  or  other  substance  passed  through  the  in- 
tegument by  means  of  a  seton-needle,  and  allowed  to  remain, 
so  that  a  discharge  is  maintained.  A  simple  seton  in  the 
case  of  an  incision  into  an  alveolar  abscess,  is  composed  of  a 
single  or  double  strand  of  floss  silk  introduced  into  a  wound 


84  DENTAL   MEDICINE. 


made  by  the  lancet,  or  into  the  orijfice  of  a  fistulous  opening, 
after  the  pus  of  the  abscess  has  been  evacuated,  to  maintain  a 
free  exit  for  the  pus  which  may  be  secreted  after  the  first 
operation ;  fine  silver  wire  is  also  employed  for  the  same 
purpose.  An  issue  is  generally  some  irritating  substance 
such  as  caustic  potassa,  or  a  small  pea,  or  piece  of  orris  root 
introduced  to  maintain  a  discharge. 

Bloodletting  is  performed  for  the  purposeof  lessening  vascu- 
lar excitement,  reducing  inflammatory  action,  relieving  con- 
gestive pain  and  spasm,  promoting  absorption,  relaxing  the 
muscles  and  arresting  hemorrhage.  It  is  divided  into  general 
and  local,  general  bloodletting  consisting  of  venesection  or 
phlebotomy,  the  median  cephalic  or  basilic  veins  of  the  arm, 
and  occasionally  the  external  jugular  and  other  veins,  being 
the  ones  selected  from  which  to  draw  the  blood.  But  it 
should  be  resorted  to  with  caution,  as  it  is  a  powerful  and 
exhausting  agent. 

Local  Bloodletting  is  chiefly  employed  for  the  relief  of  local 
inflammations  and  congestions,  and  is  accomplished  by  means 
of  leeches,  cups,  and  scarifications. 

The  leech — Jiirudo — is  commonly  employed  as  an  agent  for 
local  bloodletting,  and  is  preferable  to  "  cupping "  in  many 
local  and  chronic  forms  of  inflammation ;  also  in  infantile 
affections  which  require  such  an  operation,  when  the  Ameri- 
can leech  is  used,  and  it  makes  a  smaller  incision  than  the 
European  leech,  and  draws  less  blood.  A  leech  is  supposed 
to  draw,  on  an  average,  about  a  drachm  and  a  half  to  two 
drachms  of  blood  before  it  is  removed,  and  the  quantity  which 
subsequently  flows  will  generally  equal  that  drawn  by  the  leech. 

Leeches  are  often  applied  to  the  gum  over  the  root  of  a 
tooth  affected  with  acute  periodontitis,  to  relieve  the  inflamma- 
tion and  congestion.  To  make  the  leech  bite  readily,  the 
surface  to  which  it  is  to  be  applied  may  be  smeared  with  cream 
or  sweet  milk,  or  a  puncture  may  be  made  in  it,  so  as  to  draw 
blood,  and,  to  isolate  the  part  of  the  surface  on  which  it  is 
desired  to  apply  the  leech,  a  small  hole  may  be  made  in  a  piece 
of  bibulous  paper,  which  will  adhere  to  a  dry  surface  of  the 


THERAPEUTICS   OF   ELECTRICITY.  85 

gum,  and  afford  an  opening  for  the  mouth  of  the  leech  to  ap- 
proach the  surface. 

To  remove  a  leech,  if  it  does  not  drop  off  of  its  own  accord, 
which  they  will  generally  do  in  from  fifteen  to  twenty  minutes, 
it  may  be  sprinkled  with  a  little  cold  water  or  diluted  vinegar, 
or  powdered  sugar.  To  promote  bleeding  from  leech  bites, 
fomentations  or  warm  dry  cloths,  or  a  cupping  glass,  may  be 
used.  To  check  the  hemorrhage  from  leech  bites,  which  is 
sometimes  excessive,  firm  pressure  may  be  made  with  the 
finger,  or  exposure  to  cold  air,  or  the  application  of  such  styp- 
tics as  alum  or  matico. 

Cupping  is  employed  when  it  is  desired  to  draw  blood  rap- 
idly, or  to  ascertain  the  exact  quantity  of  blood  drawn,  or 
when  it  is  desirable  to  make  an  impression  on  the  system. 
Cupping  is  performed  by  means  of  cupping  glasses  and  a  scar- 
ificator. The  glasses  are  applied  after  being  partially  exhausted 
of  air,  when  the  removal  of  the  atmospheric  pressure  produces 
a  determination  of  blood  to  the  capillaries  of  the  part,  and  it 
is  afterwards  easily  drawn  by  scarification. 

Scarifications  consist  of  small  incisions  made  in  inflamed 
and  congested  parts,  to  relieve  the  engorged  condition  of  the 
capillary  vessels,  and  are  sometimes  employed  to  relieve  acute 
inflammation  of  the  gums  and  mucous  membrane  of  the 
mouth. 

ELECTRICITY  AS  A  THERAPEUTIC  MEANS  IN  THE  TREAT- 
MENT OF   DISEASE. 

Electricity  is  a  powerful  agent  in  many  forms  of  nervous 
disease,  especially  in  the  treatment  of  paralysis  and  neuralgia. 

Three  forms  of  electricity  are  employed,  viz. :  The  induced 
current,  the  galvanic  current,  both  of  which  are  dynamical,  and 
the  static  current,  which  is  frictional. 

Galvanic  electricity — galvanism,  and  induced  electricity — 
faradism,  are  the  two  forms  generally  employed,  frictional 
electricity  being  but  seldom  applied.  What  is  known  as  electo- 
magnetism  is  a  form  of  induced  current,  generated  by  the 
rotary  in.strument,  and  is  not  reliable.  Faradism,  so  called 
from   its  discoverer,  is  generated  by  an  instrument  which  is 


86  DENTAL   MEDICINE. 


Capable  of  applying  slow  or  rapid  shocks,  and  giving  what  is 
denominated  ^a  fine,  strong,  induced  current.  It  consists  of 
coils  of  wire ;  a  small  hammer  of  soft  iron,  attached  to  a 
spring ;  a  pole,  containing  a  platinum-pointed  screw ;  the 
hammer  breaking  the  current  in  the  coil  of  wire,  and  by  rapid 
vibration  producing  shocks. 

"The  galvanic  current  is  generated  by  a  series  of  cells,  suf- 
ficient in  number  to  cause  a  current  of  tension,  which  is  the 
resistance  offered  to  the  passage  of  a  current. 

"  One  cell  supplies  a  current,  the  poles  of  other  cells  being 
alternately  joined,  and  there  are  finally  but  two  terminal 
poles."  As  the  current  from  the  first  cell  passes  through  the 
remaining  cells,  its  power  is  increased  and  the  effect  is  gov- 
erned by  the  number  of  cells  belonging  to  the  circuit.  There 
is  also  what  is  denominated  a  current  of  "  quantity,"  which  is 
generated  by  a  large  metallic  surface  in  the  battery  cell,  the 
tension  current  being  generated  by  a  number  of  small  metal 
plates.  The  "  tension  current  "  serves  the  best  purpose  for 
medical  use,  while  the  ^'  quantity  current "  furnishes  heat,  and 
is,  therefore,  adapted  to  purposes  of  electro-surgery.  The 
modified  Bunsen  galvanic  cell  is  the  best  for  medical  pur- 
poses, although  what  is  known  as  the  Siemens  and  Halske 
cell  is  extensively  used  ;  "  it  consists  of  an  outer  cell  of  glass, 
with  elements  of  zinc  and  copper,  a  diaphragm  of  porous 
earthenware,  and  a  diaphragm  of  papier  mache,  between  the 
solutions."  The  Holtz  electric  instrument  furnishes  the  best 
static  current. 

The  Ruhmkorff  coil  is  also  employed,  in  the  use  of  which 
but  one  wire  is  brought  in  contact  with  the  patient,  the  other 
conductor  being  formed  by  the  air,  and  a  spark,  similar  to  the 
ordinary  spark  from  the  friction  machine,  being  produced. 

When  electricity  is  applied  to  the  body,  sponges  of  differ- 
ent sizes,  or  polished  metallic  surfaces,  known  as  "electrodes," 
the  metallic  being  the  best,  are  employed,  the  effect  upon  the 
skin  being  similar  to  what  is  caused  by  puncturing  with  many 
small  needles.  The  theory  of  electro-therapeutics  is  dependent 
upon  the  following  effects ; — 


THERAPEUTICS   OF   ELECTRICITY.  87 

"  If  a  portion  of  a  motor  nerve  is  included  between  the 
poles  of  a  galvanic  battery,  it  is  said  to  be  polarized,  and  in  a  , 
state  of  electrotonus.  At  the  positive  pole,  the  irritability  of 
the  nerve  is  diminished,  while  at  the  negative  it  is  excited  and 
more  susceptible  to  stimulation.  The  condition  at  the  posi- 
tive pole  is  called  anelectrotoyius,  and  that  at  the  negative  cate- 
Iccu-otoniis.  The  positive  pole  is  known  as  the  anode ;  the 
negative,  the  cathode,  and  these  give  the  name  to  the  states 
described.  A  nerve  is  said  to  be  tetanized  when  the  muscle 
supplied  is  thrown  into  a  state  of  permanent  tetanic  contrac- 
tion by  a  rapidly  intermitting  current.  The  passage  of  a 
number  of  these  shocks  for  some  time  will  diminish  the  irri- 
tability of  the  nerve  to  such  an  extent  that,  finally  there  will 
be  no  further  response.  An  ascending  current  causes  a 
greater  irritability  in  a  nerve  than  a  descending  one ;  a  de- 
scending one  depresses  excitability.  The  stimulus  is  felt  at 
the  negative  pole  when  the  current  commences,  and  when  it 
is  broken  it  is  felt  at  the  positive  pole.  A  shock  is  felt  at  the 
opening  of  the  weak  currents  ;  with  moderately  strong  ones 
it  is  felt  both  at  the  opening  and  the  closure.  With  very  strong 
currents,  it  is  impossible  to  tell  the  points  of  sensation,  as  the 
power  of  the  nerve  is  impaired."  The  action  upon  involun- 
tary muscles  is  less  than  upon  the  voluntary,  and,  as  regards 
the  latter,  it  is  the  same,  or  nearly  so,  as  long  as  the  integrity 
of  their  immediate  nerve  supply  is  concerned. 

Degenerations  and  atrophies  of  muscles  interfere  to  a  con- 
siderable extent  with  their  susceptibility  to  electric  currents ; 
hence,  it  is  better,  in  diseased  conditions,  to  pass  the  current 
through  the  nerve  trunk  which  supplies  them.  The  faradic 
current  has  but  a  local  effect,  the  deeper  muscles  and  nerves 
escaping. 

When  a  metallic  or  sponge  electrode  is  applied  to  the 
moistened  skin,  a  pricking  sensation  follows,  attended  with 
redness  and  tingling,  and  this  impression  on  the  cutaneous 
nerves  and  muscles  is  known  as  electro-muscular  sensibility. 
The  galvanic  current  occasions  a  sensation  of  warmth,  like 
that  produced  by  a  local  stimulant,  such  as  a  mustard  pla.ster, 


DENTAL   MEDICINE. 


and  when  the  faradic  current  is  appHed  to  the  dry  skin,  or 
when  the  elec^trodes  are  but  Hghtly  applied,  there  is  produced 
a  sensation  of  pain,  and  the  pain  is  the  greater  when  caused 
by  rapidly  succeeding  shocks  than  by  slow  ones. 

The  galvanic  current  causes  deeper  impressions  than  the 
faradic,  and  also  electrolytic  changes  different  from  the  faradfc, 
producing  absorption  and  changing  the  structure  of  the  dif- 
ferent tissues,  and  beneficial  results  have  resulted  from  its 
application  in  diseases  of  the  brain.  The  physical  effects  of 
the  galvanic  current  upon  the  sympathetic  nerve  are  dilatation 
followed  by  contraction  of  the  pupil,  diminished  frequency  of 
the  pulse,  and  a  lowering  of  the  tension  of  the  carotid  arteries. 
When  electricity  is  used  for  the  purpose  of  diagnosis,  the 
existence  of  local  tenderness,  exalted  sensibility,  anaesthesia, 
paralysis,  diseases  of  the  brain,  spinal  cord,  etc.,  may  be  as- 
certained. It  has  also  been  used  to  determine  the  question  of 
doubtful  death,  whether  certain  affections  are  recent  or  of  long 
standing,  and  to  detect  malingering.  As  various  nervous  dis- 
eases are  associated  with  the  loss  of  such  functions  of  muscles 
as  contraction  and  sensation,  or  the  reverse,  electricity  deter- 
mines the  extent  of  such  changes. 

When  applying  the  electric  current,  the  anatomy  of  the 
part  affected  should  be  well  understood ;  for  example,  for 
neuralgia  of  the  fifth  pair  of  nerves  one  pole  should  be 
applied  as  near  as  possible  to  the  point  of  exit  of  the  nerve 
from  the  cranium,  and  the  other  pole  to  the  remote  parts  of 
distribution. 

Galvanism  and  faradism  are  employed  for  the  relief  of 
pain  and  spasm,  to  improve  the  nutritive  processes,  and  to 
restore  deficient  muscular  power,  to  stimulate  sensation  in 
nerves,  to  stimulate  secretion,  to  influence  circulation,  to  cause 
absorption  of  fluids,  to  bring  about  the  absorption  of  morbid 
growths  and  deposits,  to  induce  sleep,  and  in  surgery,  in  the 
form  of  the  galvanic  cautery.  The  galvanic  current  is  con- 
sidered to  be  the  most  useful  for  the  mediate,  and  the  faradic 
current  for  the  immediate  application,  the  former  proving 
serviceable  in  all  forms  of  neuralgia,  and  especially  in  facial 


THERAPEUTICS   OF   ELECTRICITY.  89 

neuralgia,  and  the  latter  in  headaches,  especially  those  of  a 
rheumatic  nature. 

Galvanism  is  also  employed  with  advantage  in  sciatica, 
spinal  irritation  and  hysteria,  also  tumors,  such  as  aneurisms 
and  goitre,  these  morbid  products  being  dispersed  by  con- 
necting the  two  poles  of  a  galvanic  battery  with  needles, 
which  are  thrust  into  the  morbid  growth  and  generate  a 
process  known  as  electrolysis.  In  such  operations  bubbles 
of  hydrogen  gas  are  disengaged  at  the  negative  pole,  which 
separate  mechanically  the  adjacent  tissues,  breaking  them  up 
in  such  a  manner  that  the  disintegrated  particles  may  be 
taken  up  by  the  circulation.  Oxygen  is  disengaged  at  the 
positive  pole,  which  forms  an  acid  with  certain  elements  of 
the  tissue,  and  the  albumen  is  coagulated,  forming  a  clot  if 
this  occurs  in  a  cavity  filled  with  blood. 

For  obtunding  sensitive  dentine  and  controlling  peridental 
inflammation  by  electrolysis,  Dr.  F.  McGraw  suggests  the 
following  method  :  "To  a  12  per  cent,  solution  of  cocaine  add 
an  equal  amount  of  absolute  alcohol.  In  connection  with  this 
use  the  galvanic  current,  varying  the  power  as  the  needs  of 
each  case  may  indicate."  The  method  of  application  is  as 
follows:  "After  applying  the  rubber-dam,  wet  a  pledget  of 
cotton  in  the  solution  ;  place  it  in  the  cavity  of  the  tooth  ; 
press  the  point  of  the  positive  pole  on  to  the  cotton,  and  the 
negative  pole,  with  sponge  attachment,  to  the  cheek,  turning 
on  the  current.  An  application  of  three  minutes,  with  an 
interval  of  like  duration,  and  then  another  three-minute  ap- 
plication, is  sufficient  in  the  majority  of  cases,  although  it  is 
occasionally  necessary  to  make  the  third  application.  Then 
dry  the  cavity  thoroughly  and  begin  excavating."  In  case  of 
peridental  inflammation  use  a  stronger  current,  which  tetanizes 
the  vessels  and  causes  a  diminished  flow  of  blood  to  the  parts 
and  thus  lessens  congestion.  The  same  current  longer  con- 
tinued will  cause  electrolytic  decomposition.  "The  medicinal 
agents  he  uses  for  peridental  inflammation  and  for  blind 
abscesses  are  a  saturated  solution  of  the  chloride  of  sodium, 
seven  ounces,  tincture  of  ergot,  one  ounce.     The  treatment  of 


90  DENTAL   MEDICINE. 


blind  abscesses  requires  a  stronger  battery  power  in  order  to 
obtain  the  full  effect  of  the  electrolysis.  Dr.  Weeks  has  used 
this  method  successfully  in  the  painless  removal  of  pulps. " 

Galvaiio-  Cautery . — For  surgical  operations,  as  a  substitute 
for  the  knife  or  ecraseur,  a  platinum  wire  is  placed  between 
the  poles  of  a  powerful  battery,  the  wire  being  adjusted  in  a 
handle,  which  in  a  few  minutes  becomes  red  hot,  and  is  espe- 
cially serviceable  for  operations  in  deep  cavities  where  it 
would  be  impossible  to  use  the  knife,  the  application  of  such 
a  galvanic  cautery  being  unattended  by  pain  or  hemorrhage. 
The  Galvano-Cautery  consists  of  a  platinum  wire  loop  heated 
by  passing  a  current  of  electricity  through  it,  the  heat  being 
maintained  as  long  as  the  current  passes.  Such  an  appliance 
will  cut  through  the  tissue  to  which  it  is  applied  without 
causing  much  hemorrhage. 

Electric  portable  lamps  are  also  employed  for  illuminating 
the  mouth  and  examining  the  teeth,  and  carious  cavities  in 
them. 

Strong  currents  of  electricity  should  not  be  applied  to 
the  head,  nor  its  use  be  persevered  in  for  more  than  fifteen 
minutes  at  a  time. 

Electro-magnetism  has  been  employed  for  relieving  pain 
during  the  extraction  of  teeth,  one  pole  of  an  ordinary  battery 
being  attached  to  the  forceps  and  the  other  to  a  handle  which 
is  grasped  by  the  patient.  The  susceptibility  to  the  current  is 
first  ascertained  by  the  patient  holding  both  the  forceps  and 
the  handle  in  his  hands,  and  a  feeble  shock  applied,  which  is 
gradually  increased  until  the  sensation  is  felt  at  or  just  beyond 
the  elbows,  when  the  current  is  somewhat  reduced  in  power. 
After  the  gum  has  been  lanced,  the  connection  is  made  as 
before  described,  by  the  patient  holding  the  handle  and  the 
operator  the  forceps  in  contact  with  the  tooth  to  be  removed, 
the  handles  of  the  instrument  being  isolated,  when  the  opera- 
tion is  at  once  completed.  Great  diversity  of  opinion,  however, 
exists  as  to  the  efficiency  of  this  method,  which  has  its  advo- 
cates and  opponents. 


INCOMPATIBILITY.  91 


INCOMPATIBILITY* 

"IncoDipatibility  gives  rise  to  many  dangers  which  may  in  a 
great  measure  be  avoided  by  the  use  of  the  utmost  simpHcity 
in  prescribing.  '  The  tendency  of  the  present  age  is  toward 
mono-  rather  than  poly-pharmacy,  and  prescriptions  with  the 
orthodox  adjuvans  and  corrigcns  are  less  frequehtly  seen  than 
formerly.'     (Piffard.) 

"  This  subject  can  only  be  glanced  at  here.  The  following 
simple  rules  may  help  the  burdened  memory  of  the  practi- 
tioner : — 

"  Never  use  more  than  one  remedy  at  a  time,  if  one  will 
serve  the  purpose. 

"  Never  use  strong  mineral  acids  in  combination  with  other 
agents,  unless  you  know  exactly  what  reaction  will  ensue. 
They  decompose  salts  of  the  weaker  acids  and  form  ethers 
with  alcohol. 

"  Select  the  simplest  solvent,  diluent  or  excipient,  you  know 
of,  remembering  that  the  solvent  power  of  alcohol  and  water, 
for  their  particular  substances,  decreases  in  proportion  to  the 
quantity  of  the  other  added. 

"  Never  combine  Free  Acids  with  hydrates  or  carbonates. 
"Generally  do  not  combine  two  or  more  soluble  salts. 
"  The  following  more  or  less  insoluble  salts  will  be  formed 
whenever  the  materials  of  which  they  are  composed  are  brought 
together  in  solutions :  the  Hydrates,  Carbonates,  Phosphates, 
Borates,  Arseniates  and  Tannates  of  most  earthy  and  heavy 
metals  and  alkaloids,  and  the  metallic  Sulphides  ;  the  Sulphates 
of  Calcium,  of  Lead  and  of  the  subsalts  of  Mercury:  the 
Chlorides,  Iodides  and  Bromides  of  Bismuth,  Silver,  Lead  and 
subsalts  of  Mercury;  the  Iodides  of  Quinine,  Morphine  and 
most  alkaloids. 

^'Alkalies  precipitate  the  alkaloids  and  the  soluble  non- 
alkaline  metallic  salts,  and  (as  also  metallic  Hydrates  and 
Carbonates)  neutralize  free  acids. 

"Silver  Nitrate,  Lead  Acetate,  Corrosive  Sublimate,  Potassium 

*  S.  O.  L.  Potter,  M.D. 


92  DENTAL   MEDICINE. 


Iodide  should  nearly  always  be  prescribed  alone.  The  first 
with  Creasote  forms  an  explosive  compound.  Aconite  should 
never  be  given  in  any  vehicle  except  water. 

^^ Silver  Nitrate,  and  Lead  Acetate  and  Subacetate,  although 
incompatible  with  almost  everything,  may  be  combined  with 
Opium :  the  latter  forming  with  Opium  a  compound  which, 
although  insoluble,  is  therapeutically  active  as  a  lotion. 

"  Corrosive  Sublimate  is  incompatible  with  almost  everything, 
and  should  be  given  in  Simple  Syrup;  even  the  Compound 
Syrup  of  Sarsaparilla  is  said  to  decompose  it. 

"Tannic  Acid, 2ind  substances  containing  it,  are  incompatible 
with  albumen  and  gelatin.  Tannic  Acid,  Iodine  and  the  soluble 
Iodides  are  incompatible  with  the  alkaloids  and  substances 
containing  them,  and  with  most  soluble  m.etallic  salts.  Vege- 
table Infusions  are  generally  incompatible  with  metallic  salts. 

"  Glucosides,  such  as  Santonin  and  Colocynthin,  should  not 
be  prescribed  with  free  acids  or  Emulsin. 

^^ Dangerous  Compounds,  because  poisonous,  are :  Potassic 
Iodide  with  Potassic  Chlorate;  Hydrocyanic  acid  or  Potassium 
Cyanide  with  metallic  Hydrates,  Carbonates,  Sub-nitrates  or 
Sub-chlorides,  as  Bismuth,  Carbonate  or  Nitrate  or  Calomel. 

^^ Explosions  would  result  from  the  combination  of  powerful 
oxidizers  with  readily  oxidizable  substances,  as  Potassium 
Chlorate  or  Permanganate  with  Tannin,  Sugar,  Sulphur, 
Sulphides,  Vegetable  powders,  Glycerine,  Alcohol,  Tinctures 
or  Ether." 


POSOLOGICAL   TABLES. 


93 


TABLE  OF  THE  DOSES  OF  MEDICINES. 

Arranged  in  Alphabetical  Order,  and  Expressed  in  terms  of  both  the  Apothecaries'  and  the 
Decimal  Metric  System  of  Weights  and  Measures. 

Revised  and  Corrected  according  to  the  New  Pharmacopcjeial  Standard. 

BY  OSCAR  OLDBERG,  PH.  D. 


Remedies. 


Abstract,  aconiti 

Abstract,  aspidospermas  .  . 
Abstract,  belladonna  .  .  . 
Abstract,  cannab.  ind.  .    .    . 

Abstract,  conii 

Abstract,  coto 

Abstract,  digitalis  .... 
Abstract,  gelsemii  .... 
Abstract,  hyoscyami     .    .    . 

Abstract,  ignatioe 

Abstract,  ipecac 

Abstract,  jalaps 

Abstract,  nuc.  vom 

Abstract,  phytolaccse  .  .  . 
Abstract,  pilocarpi  .... 
Abstract,  podophylli  .  .  . 
Abstract,  sanguin.  alterat.  . 
Abstract,  sanguin.  emet.  .  . 
Abstract,  senegre.  .    .    . 

Abstract,  valerianee  .... 
Abstract,  veratr.  vir.     .    .    . 

Acet.  lobeliae 

Acet.  opii 

Acet.  sanguinar 

Acet.  scilke 

Acid.  acet.  dil 

Acid,  arsenics 

Acid,  benzoic 

Acid,  carbolic 

Acid,  citrici 

Acid,  gallic 

Acid.  gall,  in  albuminuria  . 
Acid,  hydrobrom.  dil.  .  .  . 
Acid,  hydrochlor.  dil.  .  .  . 
Acid,  hydrocyaii.  dil.  .    .    . 

Acid,  lactic 

Acid.  nitr.  dil 

Acid,  nitro-hydrochlor.  dil. 
Acid,  phosphoric  dil.  .  .  . 
Acid,  salicyl 


Dose  in  metric  weights 
or  measures. 


3  to  lo  centigrams 
0.30  to  1.20  grams 

3  to  10  centigrams 
6  to  20  centigrams 
6  to  20  centigrams 
6  to  20  centigrams 
6  to  20  centigrams 
6  to  20  centigrams 

12  to  40  centigrams 
6  to  20  centigrams 

0.20  to  2  grams     . 

0.40  to  2  grams     . 
6  to  20  centigrams 

0.30  to  I  gram  .    . 

0.40  to  2  grams     . 

25  to  60  centigrams 
6  to  20  centigrams, 

0.60  to  1.20  Gm.  . 

25  to  60  centigrams 

0.60  to  1.20  Gm.  . 
6  to  20  centigrams 
I  to  4  C.  c.  .    .    . 

0.30  to  I  C.  c.  .    . 
I  to  2  C.  c.  .    .    . 

0.60  to  2  C.  c.  .    . 

4  to  6  C.  c.  .    .    . 

1  to  5  milligrams 
0.30  to  I  Gm.    .    . 

2  to  6  centigrams 
0.60  to  2  Gm.  .  . 
0.20  to  I  Gm.  .  . 
0.60  to  4  Gm.    .    . 

I  to  2.50  C.  c. .  . 
0.60  to  2  C.  c.  .  . 
o.io  to  0.30  C.  c.  . 
I  to  4  C.  c.  .  .  . 
0.60  to  2  C.  c.  .  . 
0.30  to  1.30  C.  c.  . 
0.30  to  2  C.  c.  .  . 
0.30  to  I  Gm.    .    . 


Dose  in  apothecaries' 
weights  or  measures. 


l>^  grains. 

20  grains. 

i^  grains. 


grains. 

grains. 

grains. 

grains. 

grains. 

6  grains. 

3  grains. 

30  grains. 

30  grains. 

3  grains. 

15  grains. 

30  grains. 

10  grains. 

3  grains. 

15  grains. 

10  grains. 

15  grains. 
3  grains. 

60  minims. 

16  minims. 
30  minims. 
30  minims. 
90  minims. 
T2  grain. 
15  grains. 

I  grain. 
30  grains. 
15  grains. 
60  grains. 
40  minims. 
30  minims. 

6  minims. 
60  minims. 
30  minims. 
20  minims. 
30  minims. 
15  grains. 


94 


DENTAL   MEDICINE. 


DOSE  TABLE  CONTINUED. 


Remedies. 


Acid,  sulphuric  dil. .  .  . 
Acid,  sulphuric  arom. .  . 
Acid,  sulphuros    .... 

Acid,  tannic 

Aconitina  (white  crystals) 
Aconitina  (Duquesnel's)  . 

yEther 

Aloe 

Alonium 

Alumen 

Ammonii  benzoas  .  .  . 
Ammonii  bromid.     .    .    . 

Ammonii  carb 

Ammonii  chlorid.     .    .    . 

Ammonii  iodid 

Ammonii  phosph.     .    .    . 

Ammonii  valer 

Ammonii  valer.  elixir  .    . 

Amyl  nitris 

Amylum  iodatum  .  .  . 
Ant.  et  pot.  tartr. ;  diaph. 
Ant.  et  pot.  tartr. ;  emetic. 
Apomorph.  hydrochlor.  . 
Aqua  ammoai£e  .... 
Aqua  amygd.  amar.  .  . 
Aqua  camphoras  .... 

Aqua  chlori 

Aqua  creasoti 

Aqua  laurocerasi  .... 

Argenti  nitras 

Argenti  oxid 

Asafcetida 

Atropinse  sulph 

Auri  et  sodii  chlorid.   .    . 

Bebeerinse  sulph 

Berberina  and  its  salts  , 
Bismuthi  et  ammon.  citr. 
Bismuthi  subcarb.     .    .    . 

Bismuthi  subnitr 

Caffeinse  citras 

Calcii  carb 

Calcii  hypophosphis  .  . 
Calcii  phosphas    .... 

Calumba 

Camphora 

Cam  ph.  monobrom  .    .    . 

Capsicum 

Cerii  oxalas 

Chinoidinum 

Chloral 

Chloroformum 

Cinchona  


Dose  in  metric  weights 
or  measures. 


0.36  to  2  C.  C.    .     . 

0.30  to  2  C.  C.    .     . 

2  to  4  C.  C.    .     .     . 

10  to  60  centigrams 
0.15  to  0.30  milligr. 
0.30  to  0.50  milligr. 

2  to  4  C.  c.  .  .  , 
10  to  30  centigrams 

6  to  20  centigrams 
0.50  to  I  Gm.    .    . 
0.50  to  1.30  Gm.  . 
0.30  to  2  Gm.    .    . 
20  to  60  centigrams 

1  to  2  Gm.  .  .  . 
0.20  to  I  Gm.  .  . 
0.30  to  1.30  Gm.  . 
o.io  to  0.50  Gm.  . 

2  to  4  C.  c.  .  .  . 
0.10  to  0.40  C.  c.  . 
0.20  to  2  Gm.    .    . 

4  to  10  milligrams 
6  to  10  centigrams 

3  to  6  milligrams 
0.30  to  2  C.  c 
10  to  15  C.  c. 
15  to  60  C.  c. 

4  to  15  C.  c. 
4  to  15  C.  c. 

0.30  to  C.  c.  . 

1  to  2  centigrams 
3  to  10  centigrams 

0.30  to  1.30  Gm.  . 
0.50  to  2  milligrams 

2  to  4  milligrams 
20  to  60  centigrams 
0.20  to  I  Gm.  .  . 
0.10  to  I  Gm.  .  . 
0.40  to  2  Gm.  .  . 
0.40  to  2  Gm.    .    . 

6  to  30  centigrams 

I  to  4  Gm.  .  .  . 
0.20  to  I  Gm.   .    . 

I  to  2  Gm.  .    .    . 
0.60  to  2  Gm.    .    . 
20  to  60  centigrams 
10  to  30  centigrams 

6  to  60  centigrams 

6  to  30  centigrams 
0.20  to  2  Gm. 

0.20  to  I  Gm.  .   . 

0.05  to  0.30  C.  c. 

I  to    4  Gm.     .    . 


Dose  in  apothecaries' 
weights  or  measures. 


?00 

1_ 

"200 


I 

I 

6 

5 

1 

1 
32 

3 

3 

I 

6 

6 

I 

15 

3 

15 

10 

3 
2 
I 
I 
3 
3 
I 

15 


o  30  minims, 
o  30  minims, 
o  60  minims, 
o  10  grains, 
to  2^0  grain. 

to  T-20  gi"3-in- 
o  I  fi.  drachm, 
o  5  grains, 
o  3  grains. 
0  15  grains, 
o  20  grains. 
0  30  grains, 
o  10  grains, 
o  30  grams. 
015  grains. 
0  20  grains, 
o    8  grains, 
o  60  minims, 
o    5  minims. 
0  30  grains. 

rain, 
o  2  grains, 
o  tV  gi^ain. 
o  30  minims, 
o  4  fl.  drachms, 
o  2  fl.  oz. 
o  4  fl.  drachms, 
o  4  fl.  drachms. 
0  30  minims, 
o  /i  grain, 
o    2  grains, 
o  20  grains, 
to  3^^  grain, 
o  j\  grain. 
0  10  grains, 
o  15  grains, 
o  15  grains, 
o  30  grains, 
o  30  grains. 
5  grains, 
o  60  grains, 
o  15  grains, 
o  30  grains, 
o  30  grains, 
o  10  grains, 
o    5  grains, 
o  10  grains, 
o    5  grains, 
o  30  grains. 
0  15  grains, 
o    5  minims. 
;o  60  grains. 


POSOLOGICAL   TABLES. 


95 


DOSE  TABLE  CONTINUED. 


Remedies. 


Cinchonidina,  and  its  salts  . 
Cinchonina,  and  its  salts     . 

Cinnamomum 

Codeina 

Confeciio  sennje  .    .        .    . 

Convallamarin 

Copaiba 

Creasotum 

Creta  prrepar 

Croton  chloral 

Cubeba  

Cupri  sulphas 

Decoct,  hoematoxylon  .    .    . 

Digitalinum 

Digitalis 

Duboisina,  and  its  salts  .  . 
Elaterinum;  U.S.  P.,  l88o 
Elaterium;   U.S.  P.,  1870   . 

Ergotinum 

Eserina  and  its  salts     .    .    . 

Eserina  muriat 

Eucalyptus 

Eupatorium 

Extr.  aconiti  rad.,  U.S.P.,  18 

Extr.  aromat.  fl 

Extr.  bellad.  fol.  (Eng.)  .  . 
Extr.  bellad.  alcohol    .    .    . 

Extr.  bellad.  fol.  fl 

Extr.  bellad.  rad 

Extr.  bellad.  rad.  fl.  .  .  . 
Extr.  berber.  aquifol.  fl.  .    . 

Extr.  buchu  fl 

Extr.  calami  fl 

Extr.  calumbce 

Extr.  calumbse  fl 

Extr.  cannab.  Amer.  fl.  .  , 
Extr.  cannab.  ind.  .  .  . 
Extr.  cannab.  ind.  fl.   .    .    . 

Extr.  cantharidis  fl 

Extr.  capsici  fl 

Extr.  cardam.  comp.  fl.    .    , 

Extr.  carnis 

Extr.  cascarillse  fl 

Extr.  catechu  liquid  ,  .  , 
Extr.  chimaph.  fl.     .    ,    .    , 

Extr.  chiratae  fl 

Extr.  cimicifugae  fl.  .  .  . 
Extr.  cinchona;  .  ,  .  . 
Extr.  cinchonae  fl.  .  .  . 
Extr.  cinchonjE  arom.  fl. 
Extr.  cinchona;  comp.  fl. 
Extr.  colch.  rad , 


Dose  in  metric  weights 
or  measures. 


0.06  to  2  Gm.  .    . 
0.06  to  2  Gm,  .   . 

0  40  to  2  Gm.  .   . 

3  to  10  centigrams 

4  to  10  grams  .    . 

1  to  2  milligrams 
I  to  4  C.  c.  .  . 
0.05  to  0.20  C.  c. 

I  to    5  Gm.     .    . 

5  to  60  centigrams 
I  to    4  Gm.     .    . 
3  to  60  centigrams 

32  to  64  C.  c.     .    . 
I  to    2  milligrams 

3  to  10  centigrams 
0.50  to  I  milligram 
I  to    4  milligrams 

4  to  30  milligrams 
10  to  50  centigrams 

I  to  3  milligrams 
I  to    6  milligrams 

4  to  16  Gm.     .    . 

1  to    4  Gm.     .    . 

5  to  15  milligrams 

2  to    4  C.  c.    .    . 

I  to    4  centigrams 
1  to    3  centigrams 
0.20  to  0.40  C.  c. 
8  to  15  milligrams 
o.io  to  0.20  C.  c. 

1  to    2  C.  c.    .    . 

2  to  10  C.  c.  .  . 
I  to    4  C.  c.    .    . 

0  to  60  centigrams 

1  to  4  C.  c.  .  . 
0.20  to  I  C.  c. 

I  to    3  centigrams 
0.20  to  0.40  C.  c 
0.06  to  0.20  C.  c 
0.06  to  0.20  C.  c 
I  to    3  C.  c.    . 

1  to    4  Gm.     . 

3  to  10  C.  c.  . 
0.50  to  2  C.  c. 
3  to    5  C.  c.    . 

2  to    5  C.  c.    . 
0.50  to  2  C.  c 

1  to    2  Gm. 

2  to  4  C.  c. 
2  to  4  C.  c. 
2  to  5  C.  c. 
2  to  10  centigrams 


Dose  in  apothecaries' 
weights  or  measures. 


I  to  30  grains. 

I  to  30  grains. 

6  to  30  grains. 
^  to  2  grains. 
60  to  120  gi-ains. 

^V  to  sV  grain- 
is  to  16  minims. 

1  to    3  minims. 
15  to  75  grains. 

I  to  10  grains. 
15  to  60  grains. 
y^,  to  10  grains. 

1  to    2  fl.  ounces. 

^  to    2  grains. 
x\j  to  ^V  grain. 
~h  to  T6  grain. 
tV  to  yi.  grain. 

2  to  6  grains. 
6¥  to  5L  grain. 
A  to  tV  grain. 

I  to    4  drachms. 
20  to  60  grains. 
T2  to  %  grain. 
30  to  60  minims. 
yeto  %  grain. 
ye  to  y2  grain. 

3  to  6  minims. 
y^io  %  grain. 

I  to    3  minims. 
15  to  30  minims. 
y  to    2)^  fl.  drachms. 
15  to  60  minims. 

3  to  10  grains. 
15  to  60  minims. 

3  to  15  minims. 
yeto  y  grain. 

3  to    6  minims. 

I  to    3  minims. 

I  to    3  minims. 
15  to  45  minims. 
15  to  60  grains. 
^  to    2)4  fl.  drachms. 

8  to  30  minims. 
^  to    iX  fl.  drachms. 
X  to     ly  fl.  drachms. 

8  to  30  minims. 
15  to  30  grains. 
30  to  60  minims. 
30  to  60  minims. 
y  to    iX  fl-  drachms. 
y  lo    ly  grains. 


96 


DENTAL   MEDICINE. 


DOSE  TABLE  CONTINUED. 

Dose  in  metric  weights 

Dose  in  apothecaries' 

or  measures. 

weights  or  measures. 

Extr.  colch.  rad.  fl 

o.io  to  0.30  C.  c.    .    . 

2  to    5  minims. 

Extr.  colch.  sem.  fl 

0. 10  to  0.60  C.  c.    .    . 

lyi  to  10  minims. 

Extr.  colocynth  comp.     .    .    . 

10  to  30  centigrams  .    . 

1^2  to    5  grains. 

Extr.  conii  fol.  ale;  u.s.p  ,  70 

5  to  10  centigrams  .    . 

I  to     1)4  grains. 

Extr.  con.  [fr.]  ale.  u.s.p.,  80 

2  to    6  centigrams  .    . 

^  to     I  grain. 

Extr.  conii  fol.  fl 

0.20  to  I  C.  c.     ... 

3  to  15  minims. 

Extr.  con.  [fr.]  fl.;  U.S.P.,  80 

0.10  to  0.30  C.  e.    .    . 

I^  to    5  minims. 

Extr.  convallarise  rad.  fl.      .    . 

I  to    2  C.  c 

15  to  30  minims. 

Extr.  coptidis  fl 

2  to    4  C.  c 

30  to  60  minims. 

Extr.  corn.  flor.  fl 

2  to    4  C.  c 

30  to  60  minims. 

Extr.  cubebse  fl 

I  to    2  C.  c 

1 5  to  30  minims. 

Extr.  digitalis 

I  to    3  centigrams  .    . 

yeto  }4  grain. 

Extr.  digitalis  fl 

0.10  to  0.40  C.  c.    .    . 

I  to    6  minims. 

Extr.  ergotse 

lo  to  50  centigrams  .    . 

1)4  io    8  grains. 

Extr.  ergotee  fl 

I  to    4  C.  c 

15  to  60  minims. 

Extr.  erythroxyli  fl 

2  to    8  C.  c 

^  to  2  fl.  drachms. 

Extr.  eucalypti 

.  0.06  to  I  Gm.      .    .    . 

I  to  20  grains. 

Extr.  eucalypti  fl 

I  to    4  C.  c 

15  to  60  minims. 

Extr.  eupatorii  fl 

2  to    4  C.  e 

30  to  60  minims. 

Extr.  gelseniii  fl 

0.10  to  0.50  C.  e.    .    . 

I  to    8  minims. 

Extr.  gent 

6  to  30  centigrams  .    . 

I  to    5  grains. 

Extr.  gent,  fl 

2  to    4  C.  c 

30  to  60  minims. 

Extr.  geranii  fl 

I  to    2  C.  c 

15  to  30  minims. 

Extr.  gossypii  fl 

I  to    3  C.  c 

15  to  45  minims. 

Extr.  granati  rad.  cort.  fl.    ,    . 

3  to    8  C.  c 

3^  to    2  fl.  drachms. 

Extr.  grind,  rob.  fl 

2  to    4  C.  e 

30  to  60  minims. 

Extr.  guaranas  fl 

I  to    2  C.  c 

15  to  30  minims. 

Extr.  hcemotoxyli 

0.50  to  2  Gm.     .    .    . 

8  to  30  grains. 

Extr.  helleb.  nigris 

3  to  20  centigrams  .   . 

^  to    3  grains. 

Extr.  humuli  fl 

2  to    4  C.  c 

30  to  60  minims. 

Extr.  hydrastis  fl 

0.50  to  2  C.  c.     ... 

8  to  30  minims. 

Extr.  hyoscyami  (Engl.)      .    . 

5  to  25  centigrams  .    . 

I  to    4  grains. 

Extr.  hyoscyami  ale 

5  to  10  centigrams  .    . 

I  to    2  grains. 

Extr.  hyoscyami  fol.  fl.    .    .    . 

0.20  to  I  C.  c.     ... 

3  to  15  minims. 

Extr.  hyoscyami  sem.  fl.  .   .    . 

0.10  to  0.50  C.  c.    .    . 

2  to    8  minims. 

Extr.  ignatiae 

2  to    8  centigrams  .   . 

>^  to  IX  grains. 

Extr.  ignatiae  fl 

0.05  to  0.30  C.  c.    .    . 

I  to    6  minims. 

Extr.  ipecac  fl 

0.20  to    4  C.  c.  .    .    . 

3  to  60  minims. 

Extr.  jaborandi  fl 

2  to    8  C.  c 

^  to    2  fl.  drachms. 

Extr.  jalapse;  U.S.P.,  1870   . 

30  to  60  centigrams  .    . 

5  to  10  grains. 

Extr.  jalapjE  ale 

20  to  40  centigrams  .    . 

3  to    6  grains. 

Extr.  jalapse  fl 

I  to    4  C.  c 

15  to  60  minims. 

Extr.  junip.  fl 

2  to    4  C.  c 

30  to  60  minims. 

Extr.  kamali  fl 

2  to    4  C.  c 

30  to  60  minims. 

Extr.  kino,  liquid     ..... 

I  to    2  C.  c 

15  to  30  minims. 

Extr.  kramerise 

0.30  to  I  Gra   .... 

5  to  15  grains. 

Extr.  kramerise  fl 

2  to  4  C.  c 

30  to  60  minims. 

Extr.  lactucarii  fl 

0.50  to  2  C.  c.     ... 

8  to  30  minims. 

Extr.  lupulini  fl 

0.30  to  I  C.  c.     ... 

5  to  15  minims. 

Extr.  malti 

5  to  10  Gm 

I  to  2)4  drachms. 

Extr.  marrubii  fl 

4  to    8  C.  c 

I  to    2  fl.  drachms. 

Extr.  matico  fl 

2  to    4  C.  c 

30  to  60  minims. 

POSOLOGICAL  TABLES. 


97 


DOSE  TABLE  CONTINUED. 


Remedies. 


Extr.  nuc.  vom.  alcohol  .    . 

Extr.  opii 

Extr.  papaveris 

Extr.  papaveris  fl 

Extr.  pareirje  fl 

Extr.  physostigmae  .    .    .    . 

Extr.  piper  nigr.  fl 

Extr.  podophylii 

Extr.  prun.  virg.  fl 

Extr.  pulsatillae  fl 

Extr.  quassise 

Extr.  quassije  fl 

Extr.  quercus  fl 

Extr.  rhei 

Extr.  rhei  fl 

Extr.  ricini  fol.  fl 

Extr.  rubi  fl 

Extr.  rutae  fl 

Extr.  sabbatiae  fl 

Extr.  sabinae  fl 

Extr.  sarsap.  fl 

Extr.  sassafras  fl 

Extr.  scoparii  fl 

Extr.  Scutellariae  fl 

Extr.  senegae  fl 

Extr.  sennae  fl 

Extr.  serpent,  fl 

Extr.  spigeliae  fl 

Extr.  spigeliae  et  sennae  fl.  . 

Extr.  stillingiae  fl 

Extr.  stillingiae  comp.  fl.  . 
Extr.  stramonii  (Engl.)  .  . 
Extr.  stramonii  fol.  ale.  .  . 
Extr.  stramonii  sem.    .    .    . 

Extr.  sumbul  fl 

Extr.  taraxaci 

Extr.  taraxaci  fl 

Extr.  ustilag.  maid.  fl.     .    , 

Extr.  uvae  ursi  fl 

Extr.  valer 

Extr.  valer.  fl 

Extr.  veratr.  vir.  fl 

Extr.  viburni  opuli  fl.  .  .  . 
Extr.  viburni  [prunifol.]  fl. 

Extr.  zingiberis  fl 

Fel  bovis  purif. 

Ferri  arsen 

Ferri  carb.  sacch 

Ferri  chloric! 

Ferri  citr 

Ferri  et  ammon.  citr.  .  .  . 
Ferri  et  ammon.  sulph.    .    , 

7 


Dose  in  metric  weights 
or  measures. 


I  to  3  centigrams    , 
I  to  3  centigrams    , 

3  to  12  centigrams  . 

1  to  3  C.  c 

2  to  4  C.  c.  .    .    . 

4  to  lo  milligrams  . 

1  to  3  C.  c.  .    .    .    , 

3  to  lo  centigrams  , 

2  to  4  C.  c 

o.io  to  0.30  C.  c.  . 

6  to  30  centigrams  , 

2  to  4  C.  c 

2  to  4  C.  c 

0.30  to  I  Gm.    .    .    , 

1  to  3  C.  c.  .    .    ,    , 

2  to  8  C.  c.  .    .    .    , 
I  to  4  C.  c.  .    .    .    , 

1  to  2  C.  c.  .    .    .    , 

2  to  4  C.  c.  ,    .    .    , 
0.30  to  I  C.  c.    .    .    , 

2  to  8  C.  c.  .    .    ,    . 

2  to  8  C.  c 

2  to  4  C.  c.  .    .    .    , 
2  to  8  C.  c.      .    .    , 
0.50  to  I  C.  c.   .    . 

4  to  15  C.  c.    .    . 
2  to    4  C.  c.    .    . 

1  to    4  C.  c.    .    . 

2  to    8  C.  c.    .    , 
2  to    8  C.  c.    ,    . 

2  to    8  C.  c.    .    , 

3  to    6  centigrams 
2  to    4  centigrams  , 
I  to    3  centigrams 

1  to  4  C.  c.  .  . 
0.30  to  1  Gm,    .    . 

2  to  8  C.  c.  .    .    , 

1  to  4  C.  c.  .    .    . 

2  to  4  C.  c.  .  .  . 
0.30  to  I  Gm.    .    . 

2  to  4  C.  c.  .  .  . 
0.6  to  0.30  C.  c.    . 

4  to  8  C.  c.  .    .    . 

4  to  8  C.  c.  .  .  . 
0.50  to  2  C.  c.  .  . 
20  to  40  centigrams 

6  to  12  milligrams 
0.25  to  I  Gm.    .    . 

5  to  20  centigrams 
30  to  60  centigrams 
30  to  60  centigrams 
30  to  60  centigrams 


Dose  in  apothecaries' 
weights  or  measures. 


'A 


yi  grain. 

A  grain. 

2  grains. 

45  minims. 

60  minims. 

Ve  grain. 

45  minims. 

l}4  grains, 
i  60  minims. 
5  minims. 
5  grains. 

60  minims. 

60  minims. 

15  grains. 
'  45  minims, 

2  fl.  drachms. 

60  minims. 

30  minims. 

60  minims. 
I  15  minims. 
'  2  fl.  drachms, 

2  fl.  drachms, 
I  I  fl.  drachm. 
I  2  fl.  drachms, 
1  15  minims. 
1    4  fl.  drachms, 
1  60  minims, 
1  60  minims. 
1  2  fl.  drachms. 
I  2  fl.  drachms. 
I  2  fl.  drachms, 
I  I  grain. 

>  %  grain, 
1  yi.  grain. 

1  60  minims. 
I  15  grains. 
I    2  fl.  drachms. 
I  60  minims. 

>  60  minims, 
p  15  grains. 

I  60  minims. 
I  5  minims. 
I  2  fl.  drachms. 
I  2  fl.  drachms. 
I  30  minims. 
•    6  grains. 
(  ^  grain. 
I  15  grains. 
(    3  grains. 
I  10  grains. 
(  10  grains. 
I  10  grains. 


98 


DENTAL   MEDICINE. 


DOSE  TABLE  CONTINUED. 

Dose  in  metric  weights 

Dose  in  apothecaries' 

or  measures. 

wei 

ghts  or  measures. 

Ferri  et  ammon.  tartr 

0.30  to  I  Gm 

Sto 

15  grains. 

Ferri  et  cinchonid.  citr.   .    .    . 

30  to  60  centigrams  .    . 

5  to 

10  grains. 

Ferri  et  pot.  tartr 

I  to    4  Gm 

15  to  60  grains. 

Ferri  et  quin.  citr 

30  to  60  centigrams  .    . 

Sto 

10  grains. 

Ferri  et  strychn.  citr 

5  to  30  centigrams  .    . 

I  to 

5  grains. 

Ferri  ferrocyanid 

20  to  30  centigrams  .    . 

3  to 

5  grains. 

Ferri  hypophosphis 

30  to  60  centigrams  .    . 

5  to 

10  grains. 

Ferri  lactas 

5  to  20  centigrams  .    . 

I  to 

3  grains. 

Ferri  oxalas 

5  to  20  centigrams  .    . 

I  to 

3  grains. 

Ferri  oxid.  hydrat 

1 5  to  60  Gm 

Y7A0 

2  ounces. 

Ferri  phosphas     ...... 

5  to  30  centigrams  .    . 

I  to 

5  grains. 

Ferri  pyrophosphas 

5  to  30  centigrams  .    . 

I  to 

5  gi-ams. 

Ferri  subcarb 

0.30  to  2  Gm 

5  to 
I  to 

30  grains. 
3  grains. 

Ferri  sulphas 

5  to  20  centigrams  .    . 

Ferri  sulplias  exsiccat.     ,    .    . 

3  to  10  centigrams  .    . 

^to 

1)4  grains. 

Ferri  valer 

5  to  20  centigrams  ,    . 

I  to 

3  grams. 

Ferrum  dialys 

0.60  to  4  C.  c 

10  to 
I  to 

6c  minims. 

Ferrum  reduct 

6  to  30  centigrams  .    . 

5  grains. 

Gentiana 

0.60  to  2  Gm 

10  to 

30  grains. 
tV  grain. 

Hydrarg.  chlorid.  corros.     .    . 

I  to    6  milligrams  .    . 

l^TtO 

Hydrarg.  chlorid.  mite.  .    ,    . 

I  to  50  centigrams  .    . 

■/^to 

8  grains. 

Hydrarg.  cyanid 

3  to    6  milligrams  .    . 

yVto 

j\  grain. 

Hydrarg.  iodid.  rubr 

4  to  30  milligrams  .    . 

xVto 

Y  grain. 

Hydrarg.  iodid.  vir.     .    .    . 

I  to    6  centigrams  .    . 

/6to 

I  grain. 

Hydrarg.  subsulphas  flav.    .    . 

15  to  60  milligrams  .    . 

5<to 

I  gram. 

Hydrarg.  c.  creta 

15  to  50  centigrams  .    . 

3  to 

8  grains. 

Infusum  brayeras 

60  to  250  C.  c 

2  to 

8  fl.  ounces. 

Infusum  catechu  comp.   .    .    . 

30  to  60  C.  c 

I  to 

2  fl.  ounces. 

Infusum  columbse 

15  to  60  C.  c 

'X  to 

2  fl.  ounces. 

Infusum  digitaHs 

8  to  15  C.  c 

2  to 

4  fl.  drachms. 

Infusum  eupatoris 

30  to  60  C.  c 

I  to 

2  fl.  ounces. 

Infusum  gentiana  comp.  .    ,    . 

4  to  30  C.  c 

I  to 

8  fl.  drachms. 

Infusum  pruni  virginianse.  .    . 

15  to  60  C.  c 

Kto 

2  fl.  ounces. 

Infusum  quassias 

8  to  60  C.  c 

%to 

2  fl.  ounces. 

Infusum  sennae  comp 

30  to  60  C.  c 

I  to 

2  fl.  ounces. 

Ingluvin 

0.30  to  I  Gra 

5  to  20  grains. 
I  to    3  grains. 

lodoformum 

5  to  20  centigrams  .    . 

lodum 

I  to    3  centigrams  .    . 
I  to    6  centigrams  .    . 
I  to    2  Gm 

Veto 
Veto 
15  to 

}4  grain. 

I  grain. 

30  grains. 

Ipecacuanha    jgjjfg^j*^'"  *    '    " 

Talapa 

I  to    2  Gm 

15  to 
I  to 
8  to 

30  grains. 

Kamala 

4  to    8  Gm 

0.50  to  2  Gm.    .    . 

Kino 

30  grains. 
15  grains. 
8  fl.  drachms. 

Lactucarium 

0.50  to  I  Gm 

8  to 
2  to 

Liq.  ammon.  acet 

8  to  30  C.  c 

Liq.  arsen.  et  hydr.  iod.  .    .    . 

o.io  to  0.50  C.  c.  .   .    . 

2  to 

7  minims. 

Liq.  ferri  nitrat 

0.50  to  I  C.  c 

8  to 

15  minims. 

Liq.  iodi.  comp 

0.30  to  1  C.  c 

?  to  2r)  minims 

Liq.  magnes.  citratis  .... 

60  to  250  C.  c 

2  to 

8  fl.  ounces. 

Liq.  pepsina 

8  to  15  C.  c 

2  to 

4  fl.  drachms. 

Liq.  potassse 

0.30  to  I  C.  c 

5  to  20  minims. 

Liq.  potassii  arsenit ..... 

0.15  to  0.50  C.  c.      .    . 

3  to 

7  minims. 

POSOLOGICAL   TABLES. 


99 


DOSE  TABLE  CONTINUED. 


Remedies. 


Dose  in  metric  weights 
or  measures. 


Dose  in  apothecaries' 
weights  or  measures. 


Liq.  potassii  citrat.  ,    .    . 

Liq.  sodffi 

Liq.  sodii  arseniatis .    .    . 

Lithii  benzoas 

Lithii  bromid 

Lithii  carb 

Lilhii  citr 

Lithii  salicylas     .... 

Lupulinum 

Magnesia 

Magnesii  carb 

Magnesii  citr.  gran.  .  . 
Magnesii  sulphas .... 
Magnesii  sulphis  .... 
Mangani  sulphas  .... 

Manna 

Massa  copaibse 

Massa  ferri  carb 

Massa  hydrarg 

Mist,  ammoniaci.  .  .  . 
Mist,  asafoetidae  .... 
Mist,  cartiphora  (Hopis)  . 
Mist,  chloroformi .... 
Mist,  cretse    ...... 

Mist,  ferri  comp 

Mist,  ferri  et  ammon.  acet. 
Mist,  glycrrh.  comp.  .  . 
Mist,  magnes.  et  asafoet.  . 
Mist.  pota.ssii  citr.  .  .  . 
Mist,  rhei  et  sodae  .  .  . 
Morphina  and  its  salts  .    . 

Moschus 

Mucil.  acacise 

Narceina 

Is'itroglycerinum  .... 

Nux  vomica 

Oleoresina  a.spidii  .  .  . 
Oleoresina  capsici  .  .  . 
Oleoresina  cuDebse  .  .  . 
Oleoresina  lupulini  .  .  . 
Oleoresina  piperis  .  .  . 
Oleoresina  zingiberis  .  . 
Oleum  copaibae    .... 

Oleum  cubebae 

Oleum  eucalypti  .... 
Oleum  morrhua  .... 
Oleum  phosphoratum  ,    . 

Oleum  ricini 

Oleum  sahinae 

Oleum  terebinth 

Oleum  tiglii 

Opium  (14^  morphine)  . 


8  to  15  C.  c.  .  .  . 
0.30  to  I  C.  c.  .  .  . 
0.15  to  0.50  C.  c.  .  . 
10  to  30  centigrams  . 

6  to  30  centigrams  . 
10  to  40  centigrams  . 
10  to  30  centigrams  . 
10  to  50  centigrams  . 
30  to  60  centigrams  . 

1  to    4  Gm.     .    .    . 

I  to    4  Gm.     .    .    . 

8  to  30  Gm.     .    .    . 

8  to  30  Gm.  .  .  . 
0.50  to  2  Gm.  .  ,  . 
10  to  60  centigrams  . 
30  to  60  Gm.  .  .  . 
0.30  to  2  Gm.  .  .  . 
0.30  to  I  Gm.  .  .  . 
0.06  to  I  Gm.  .  .  . 
15  to  30  C.  c.  .  .  . 
15  to  30  C.  c.    .    .    . 

4  to  32  C.  c.  .  .  . 
15  to  30  C.  c.  .  .  . 
30  to  60  C.  c.  .  .  . 
15  to  60  C.  c.  .  .  . 
15  to  30  C.  c.    ... 

4  to  15  C.  c.    .    .    . 

4  to  15  C.  c.  .  .  . 
15  to  60  C.  c.  .  .  . 
15  to  30  C.  c.    .    .    . 

4  to  30  milligrams  . 
0.10  to  I  Gm.    .    .    , 

4  to  32  C.  c.  .  .  . 
I  to  10  centigrams  . 
I  to    4  milligrams  . 

5  to  30  centigrams  . 
I  to    4  C.  c.    .    .    . 

0.06  to  0.30  C.  c.  .  . 
0.30  to  2  C.  c.  .  .  . 
0.30  to  I  C.  c.  .  .  . 
0.06  to  0.20  C.  c.  .  . 
0.06  to  0.20  C.  c.  .  . 
0.50  to  I  C.  c.  .  .  . 
0.30  to  I  C.  c.  .  .  . 
0.60  to  2  C.  c.   .    .    . 

4  to  16  C.  c.  .  .  . 
0.05  to  0.20  C.  c.  .    . 

4  to  32  C.  c.  .  .  . 
0.06  to  0.20  C.  c.  .  . 
0.30  to  2  C.  c.  .  .  . 
0,30  to  o.io  C.  c.  .    . 

I  to  10  centigrams  . 


o    4  fl.  drachms. 
;o  15  minims. 
;o    7  minims. 
;o    5  grains. 
0    3  grains. 
:o    6  grains. 
;o    5  grains. 

8  grains. 
;o  10  grains. 
;o  60  grains, 
to  60  grains. 

8  drachms. 
0    8  drachms. 
.0  30  grains. 
0  10  gi-ains. 

2  ounces. 
0  30  giains. 
:o  15  grains. 
;o  15  grains. 
:o    8  fl.  drachms. 

8  fl.  drachms. 
;o    8  fl.  drachms. 
;o    8  fl.  drachms. 
;o    2  fl.  ounces, 
to    2  fl.  ounces. 

I  fl.  ounce. 
;o    4  fl.  drachms. 
0    4  fl.  drachms. 
;o    2  fl.  ounces. 

1  fl.  ounce. 
;o  yi  grain. 

to  15  grains. 

:o    8  fl.  drachms. 

2  grains, 
to  tV  grain. 
;o  5  grains. 
;o  60  minims. 

3  minims. 
to  30  minims. 
0  20  minims. 
;o    3  minims. 

3  minims. 
0  15  minims. 
015  minims. 
:o  30  minims, 
to    4  fl.  drachms. 

3  minims. 
;o    8  fl.  drachms. 

3  minims, 
:o  30  minims. 
;o  2  minims, 
o  Ij4  grains. 


100 


DENTAL  MEDICINE. 


DOSE  TABLE  CONTINUED. 


Remedies. 


Pancreatine 

Pepsinum  purum 

Pepsinum  saccharatum    ,    .    . 

Phosphorus  

Pilocarpina  (and  salts)    .    .    . 

Pil.  aloes 

Pil.  aloes  et  asafoet 

Pil.  aloes  et  ferri 

Pil.  aloes  et  mast 

Pil.  aloes  et  myrrhse 

Pil.  antimon.  comp 

Pil.  asafoetidse 

Pil.  cathart.  comp 

Pil.  ferri.  comp 

Pil.  ferri  iodidi 

Pil.  galbani  comp 

Pil.  opii 

Pil.  phosphori 

Pil.  rhei 

Pil.  rhei  comp 

Plumbi  acetas 

Plumbi  iodidum 

Potassii  acetas 

Potassii  bicarb 

Potassii  bitartr 

Potassii  bromid 

Potassii  carb 

Potassii  chloras 

Potassii  citras 

Potassii  cyanid 

Potassii  et  sodii  tartr 

Potassii  hypophosphis  .... 

Potassii  iodJid 

Potassii  nitras 

Potassii  sulphas 

Potassii  sulphidum 

Potassii  sulphis 

Potassii  tartras 

Prunus  Virginianum    .... 

Pulv.  aromat 

Pulv.  cretse  comp 

Pulv.  effervescent  aperient  (seid- 
litz  powder) 

Pulv.  glycyrrh.  comp 

Pulv.  ipecac,  et  opii     .... 

Pulv.  jalapse  comp 

Pulv.  rhei  comp 

Quassia 

Quinidina  (and  salts)  .... 

Quinina  (and  salts) 

Resina  jalapse 

Resina  podophylli 


Dose  in  metric  weights 
or  measures. 


0.30  to  I  Gm.    .     .  . 

I  to  15  Gm 

0.60  to  I  Gm.  .  .  , 
0.50  to  3  milligrams 

I  to  30  milligrams  . 

1  to    3  pills  .  .    .  . 

2  to  5  pills  .  .  .  . 
I  to    3  pills  .  .    .  . 

1  to    3  pills  .  .    .  , 

2  to  5  pills  .  .  .  . 
I  to  3  pills  .  .  .  . 
I  to    6  pills  .  .    .  . 

1  to    4  pills  .  .    .  . 

2  to  5  pills  .  .  ,  . 
I  to  4  pills  .  .  .  . 
I  to  5  pills  .  .  , 
I  to    2  pills     .    .  . 

1  to    4  pills     .    .  . 

2  to    5  pills     .    .  . 

2  to    5  pills     .    .  . 

3  to  20  centigrams  . 

3  to  20  centigrams  . 
I  to    4  Gm.     .    .  , 

0.50  to  4  Gm.    .    .  . 

I  to  8  Gm 

0.50  to  4  Gm.    .    .  . 

0.50  to  2  Gm.    .    ,  , 

0.50  to  2  Gm.    .    .  , 

I  to    4  Gm.     .    .  , 

4  to  8  milligrams  , 
15  to  30  Gm.  .  .  . 
0.30  to  I  Gm.  .  .  , 
o.io  to  I  Gm.  .  .  , 
0.50  to  I  Gm.    .    .  . 

4  to  15  Gm.     .    .  . 

5  to  60  centigrams  . 

1  to  2  Gm.  ,  .  . 
5  to  30  Gm.    .    .  . 

2  to  4  Gm.  .  .  . 
0.50  to  2  Gm.  ,  .  . 
0.50  to  2  Gm.   .    .  , 


2  to  4  Gm.  .  . 
0.30  to  I  Gm.    .    . 

2  to    4  Gm.    .    . 

2  to  4  Gm,  .  . 
0.60  to  4  Gm,  .  . 
0.05  to  2  Gm.  ,  , 
0.05  to  2  Gm.  .  . 
10  to  30  centigrams 

8  to  30  centigrams 


Dose  in  apothecaries' 
weights  or  measures. 


5  to  20  grains. 
15  grains  to  ^  ounce. 
10  to  20  grains, 
xk  to  2^0  grain, 
^?  to  Yi  gram 

1  to 

2  to 
I  to 

1  to 

2  to 
I  to 
I  to 

1  to 

2  to 

I  to 
I  to 
I  to 

1  to 

2  to 
2  to 

;^to 
'/^to 


3  pi 
5  pi 
3  pi 
3  pi 

5  pi 

3  pi 

6  pi: 

4  pi 

5  pi 

4  pi 

5  pi 

2  pi 

4  pi 

5  pi 
5  pi 

3  grams. 
3  grains. 

15  to  60  grains. 

8  to  60  grains. 
15  to  120  grains. 

8  to  60  grains. 

8  to  30  grains. 

8  to  30  grains. 
15  to  60  grains. 
T6  to  y%  grain. 
3^  to    I  ounce. 

5  to  15  grains. 

2  to  15  grains. 

8  to  15  grains. 

I  to    4  drachms. 

I  to  10  grains. 
15  to  30  grains. 

I  to    8  drachms, 
i^  to    I  drachm. 

8  to  30  grains. 

8  to  30  grains. 

Chart.  No.  i. 


30  to 
5  to 
30  to 
30  to 
10  to 
I  to 

1  to 

2  to 

;^to 


60  grains. 
15  grains. 
60  grains. 
60  grains, 
60  grains. 
30  grains. 
30  grains. 
5  grains. 
Yz  grain. 


POSOLOGICAL   TABLES. 


101 


DOSE  TABLE  CONTINUED. 


Remedies. 


Dose  in  metric  weights 
or  measures. 


Dose  in  apothecaries' 
weights  or  measures. 


Resina  scammonii    .    .    . 

Rheum 

Salicinum 

Santonica 

Santuninum 

Sapo 

Scammonium 

Senna    

Sodii  acetas 

Sodii  arsenias 

Sodii  benzoas 

Sodii  bicarb 

Sodii  bisulphis 

Sodii  boras 

Sodii  bromid 

Sodii  carb 

Sodii  carb.  exsicc.    .    .    . 

Sodii  chloras 

Sodii  hypophosphis  .  .  . 
Sodii  hyposulphis     .    .    . 

Sodii  iodidum 

Sodii  phosphas 

Sodii  salicylas 

Sodii  santoninas   .... 

Sodii  sulphas 

Sodii  sulphis 

Spir.  aether,  comp.  .  .  . 
Spir.  aether,  nitrosi  .  .  . 
Spir.  ammoniae  .... 
Spir.  ammoniae  arom.  .  . 
Spir.  camphorae  .... 
Spir.  chloroformi  .... 

Spir  frumentis 

Spir.  vini  gallici 

Spir.  juniper 

Spir.  lavend.  comp. .    .    . 

Spir.  menth.  pip 

Strychnina  (and  salts) .   . 

Succus  conii 

Succus  limonis 

Sulphur 

Syrupus  calcii  lactophos. 

Syrupus  calcis 

Syrupus  fern  bromidi  .  . 
Syrupus  ferri  iodidi  .  . 
Syr.  fer.  manganese  iodidi 
Syrupus  ferri  oxidi  .  .  . 
Syrupus  ferri  hypophosph. 
Syr.  fer.  quin.  et  str.  phos. 
Syrupus  h\pophosphit.  . 
Syrupus  hyp^jphos.  c.  fer. 
Syrupus  ipecac 


lo  to  60  centigrams  . 
o.  10  to  2  Gm.  .  .  . 
0.50  to  2  Gm.  .  .  . 
0.50  to  4  Gm.    .    .    . 

6  to  30  centigrams  . 
0.30  to  2  Gm.  .  .  . 
0.20  to  I  Gm.  .  .  . 
0.50  to  4  Gm.    .    .    . 

I  to  4  Gm 

1  to  6  milligrams  . 
0.30  to  I  Gm.  .  .  . 
0.50  to  2  Gm.  .  .  . 
0.50  to  2  Gm.  .  .  . 
0.50  to  2  Gm.  . 
0.50  to  2  Gm.  .  .  . 
0.50  to  2  Gm.  ,  .  . 
0.30  to  I  Gm.  .  .  . 
0.30  to  2  Gm.  .  .  . 
0.50  to  I  Gm.  .  .  . 
0.50  to  2  Gm.  .  .  . 
0.30  to  I  Gm.  .  .  . 
o.io  to  I  Gm.  .  .  . 
0.30  to  2  Gm.  .  .  . 
15  to  60  centigrams  . 

4  to  30  Gm.  .  .  . 
0.50  to  2  Gm.    .    .    . 

2  to  4  C.  c 

2  to  8  C.  c 

0.50  to  2  C.  c.  .    .    . 

I  to  4  C.  c 

0.50  to  2  C.  c.  .    .    . 

1  to  4  C.  c 

4  to  16  C.  c.  .  .  . 
4  to  1 6  C.  c. 

4  to  16  C.  c.    .    .    . 

2  to  4  C.  c.  .  .  . 
2  to    4  C.  c.    .    .    . 

1  to    5  milligrams  . 

2  to  16  C.  c.    .    .    . 

4  to  8  C.  c.  .  .  . 
2  to  15  C.  c.    .    ,    . 

5  to  10  C.  c.  .  .  . 
I  to  2  C.  c.  .  .  . 
I  to    4  C.  c.    .    .    . 

1  to  4  G.  c.  .  .  . 
0.60  to  4  C.  c.   .    .    . 

5C.  c 

5C.C 

5  C.  c 

5  G.  c 

5  C.  c 

2  to  15  C.  c.    .    ,    . 


2  to  10  grains. 

2  to  30  grains. 
8  to  30  grains. 
8  to  60  grains. 

1  to  5  grains. 
5  to  30  grains. 

3  to  15  grains. 
8  to  60  grains. 

15  to  60  grains. 
??  to  iV  grains. 

5  to  15  grains. 

8  to  30  grains. 

8  to  30  grains. 

8  to  30  grains. 

8  to  30  grains. 

8  to  30  grains. 

5  to  15  grains. 

5  to  30  grains. 

8  to  15  grains. 

8  to  30  grains. 

5  to  15  grains. 

2  to  15  grains. 
5  to  30  grains. 
2  to  10  grains. 

I  to    8  drachms. 

8  to  30  grains. 
30  to  60  minims. 
^  to  2  fl.  drachms. 

8  to  30  minims. 
15  to  60  minims. 

8  to  30  minims. 
15  to  60  minims. 

I  to    4  fl.  drachms, 

I  to    4  fl.  drachms. 

I  to    4  fl.  drachms. 
30  to  60  minims. 
30  to  60  minims. 

j4  to    4  fl.  drachms. 

I  to    2  fl.  drachms. 
^  to    4  drachms. 

I  to    2  fl.  drachms. 
15  to  30  minims. 
15  to  60  minims. 
15  to  60  minims. 
10  to  60  minims. 

1  fl.  drachm. 

I  fl.  drachm. 

I  fl.  drachm. 

I  fl.  drachm. 

I  fl.  drachm. 
^  to  4  fl.  drachms. 


102 


DENTAL   MEDICINE. 


DOSE  TABLE  CONTINUED. 


Remedies. 


Syrupus  lactucarii 

Syrupus  pruni  virginiani  .    . 

Syrupus  rhei 

Syrupus  rhei  arom 

Syrupus  rosse 

Syrupus  rubi 

Syrupus  sarsap.  comp.  .  .    . 

Syrupus  scillae 

Syrupus  scillae  comp.    .    .    . 

Syrupus  senegae 

Syrupus  sennse 

Syrupus  tolutan 

Tinct.  aconiti  fol 

Tinct.  aconiti  rad 

Tinct.  aeon.  rad.  Fleming's 
Tinct.  aloes  (1880)  .  .  .  , 
Tinct.  aloes  et  myrrhse  .  .    . 

Tinct.  amicae  flor 

Tinct.  amicse  rad 

Tinct.  asafoetidse 

Tinct.  belladonnse 

Tinct.  calumbae 

Tinct.  cannabis  ind 

Tinct.  cantharid 

Tinct.  capsici 

Tinct.  catechu 

Tinct.  cimicifugse 

Tinct.  cinchonse 

Tinct.  cinchonse  comp.  .  .    . 

Tinct.  colchici  sem 

Tinct.  conii 

Tinct.  cubebse 

Tinct.  digitalis 

Tinct.  eucalypti 

Tinct.  ferri  chloridi  .  .  .  . 
Tinct.  ferri  chloridi  aether  . 
Tinct.  gentian  comp.    .    .    . 

Tinct.  gelsemii 

Tinct.  guaiaci 

Tinct.  guaiaci  ammon.  .    .    , 

Tinct.  humuli 

Tinct.  hydrastis 

Tinct.  hyoscyami  fol.  .  .  , 
Tinct.  hyoscyami  sem. .    .    . 

Tinct.  iodi 

Tinct.  ipecac,  et  opii.   .    .    . 

Tinct.  jalapae 

Tinct.  kino 

Tinct.  krameriae 

Tinct.  lavend.  comp.     .    .    . 

Tinct.  lobeliae 

Tinct.  lupulini 


Dose  in  metric  weights 
or  measures. 


5  to  10  C.  c.  . 

4  to  16  C.  C.  . 

4  to  15  C.  C.  , 

4  to  15  C.  c.  . 

4  to  8  C.  c.  . 

4  to  8  C.  c.  . 

4  to  15  C.  c.  . 

2  to  4  C.  c.  . 

1  to  4  C.  c.  . 

4  to  8  C.  c.  . 

5  to  15  C.  c.  . 
4  to  32  C.  c.  . 

0.50  to  I  C.  c.  . 

0.06  to  0.30  C.  c. 

0.04  to  0.15  C.  c. 

2  to  8  C.  c.  . 
4  to  8  C.  c.  . 

0.50  to  2  C.  c.  . 

1  to  2  C.  c.  . 

2  to  4  C.  c.  . 
0.20  to  I  C.  c.  . 

3  to  15  C.  c.  . 

0.30  to  2  C.  C.  . 

0.06  to  0.60  C.  c. 

0.30  to  2  C.  C.  . 

2  to  8  C.  c.  . 

2  to  4  C.  c.  . 

2  to  8  C.  c.  . 

2  to  8  C.  c.  . 
0.30  to  I  C.  c.  . 

0.30  to  2  C.  C.  . 

4  to  8  C.  c.  . 
0.30  to  I  C.  c.  . 

3  to  8  C.  c.  ,  , 
I  to  2  C.  c.  .  . 

1  to  2  C.  c.  .  . 

3  to  8  C.  c.  .  . 
0.50  to  I  C.  c.  . 

2  to  4  C.  c.  .  . 
2  to  4  C.  c.  .  . 

4  to  10  C.  c.  . 
2  to  6  C.  c.  .  . 
I  to  4  C.  c.  .  . 

1  to  2  C.  c.  .  . 
0.30  to  I  C.  c.  . 
0.30  to  I  C.  c.  . 

2  to  8  C.  c.  .  . 
2  to  8  C.  c.  .  , 
2  to  8  C.  c.  .  . 
2  to  8  C.  c.  .  . 

1  to  3  C.  c.  .  . 

2  to  8  C.  c.  .  . 


Doses  in  apothecaries' 
weights  or  measures. 


I  to    3  fl.  drachms. 

I  to    4  fl.  drachms. 

I  to    4  fl.  drachms. 

I  to    4  fl.  drachms. 

I  to    2  fl.  drachms. 

I  to    2  fl.  drachms. 

I  to  4  fl.  drachms. 
^  to  I  fl.  drachm. 
1 5  to  60  minims. 

I  to    2  fl.  drachms. 

I  to    4  fl.  drachms. 

I  to    8  fl.  drachms. 

8  to  16  minims. 

I  to    5  minims. 
^  to  2^  minims, 
j^  to    2  fl.  drachms. 

I  to    2  fl.  drachms. 

8  to  30  minims. 
1 5  to  30  minims. 
30  to  60  minims. 

3  to  15  minims. 

I  to    4  fl.  drachms. 

5  to  30  minims. 

I  to  10  minims. 

5  to  30  minims. 
^  to    2  fl.  drachms. 
30  to  60  minims. 
^  to    2  fl.  drachms. 
^  to    2  fl.  drachms. 

5  to  15  minims. 

5  to  30  minims. 

I  to    2  fl.  drachms. 

6  to  15  minims. 
^  to  2  fl.  drachms. 
15  to  30  minims. 
15  to  30  minims. 

j^  to  3  fl.  drachms. 

8  to  15  minims. 
30  to  60  minims. 
30  to  60  minims. 

I  to  2^  fl.  drachms. 
30  to  90  minims. 
15  to  60  minims. 
15  to  30  minims. 

5  to  15  minims. 

5  to  15  minims. 

^  to  2  fl.  drachms. 

^  to  2  fl.  drachms. 

^  to  2  fl.  drachms. 

^  to  2  fl.  drachms. 

5  to  45  minims. 

^  to  2  fl.  drachms. 


POSOLOGICAL  TABLES. 


103 


DOSE  TABLE  CONTINUED, 


Remedies. 


Dose  in  metric  weights 
or  measures. 


Tinct.  matico  .  .  . 
Tine.  nuc.  vomicae  . 
Tine,  opii  deodorat  . 
Tinet.  opii  caniph.  . 
Tinct.  physostigniatis 
Tinct.  pyrethri  .  .  . 
Tinct.  quassise  .    .    . 

Tinct.  rhei 

Tinct.  sanguinarije  . 
Tinct.  scillK  .... 
Tinct.  seq^entarice  . 
Tinct.  stramon.  fol.  . 
Tinct.  stramon.  sem. 
Tinct.  sumbul  .  .  . 
Tinct.  tolutan.   .    .    . 

Tinct.  valer 

Tinct.  valer.  amon.  . 
Tinct.  veratr.  vir.  .  . 
Tinct.  zingiberis  .  . 
Tritur.  elaterini     .    . 

Uva  ursi 

Veratrini 

Vin.  aloes 

Vin.  antim    <      P." 
l^  emet  . 

Vin.  colch.  rad.     .    . 

Vin.  colch.  sem.    .    . 

Vin.  ergotae  .... 

Vin.  ferri  amar.     .    . 

Vin.  ferri  citrat.     .    . 

Vin.  xericum.    .    .    . 

....  f  expect. 

V  m.  ipecac,  i   .      . 

Vin.  opii 

Vin.  portense    .    .    . 

Vin.  rhei 

Zinci  acet 

Zinci  oxid 

Zinci  sulpha.s  emet  . 
Zinci  valerianas    .    . 


et.     alt 


2  to  8  C.  c 

o.o6  to  o.6o  C.  c.  .  . 
0.30  to  2  C.  c.  .  .  . 
0.50  to  5  C.  c.  .  .  . 
0.30  to  I  C.  c.  .  .  , 
0.50  to  2  C.  c.   .    .    . 

2  to  8  C.  c 

4  to  30  C.  c.    .    .    . 

1  to  4  C.  c 

0.50  to  4  C.  c.   .    .    . 

2  to  8  C.  c 

0.50  to  I  C.  c.  .  .  . 
0.30  to  I  C.  c.  .  .  . 
0.50  to  :^  C.  c.   .    .    . 

4  to  8  C.  c 

2  to  8  C.  c 

2  to  8  C.  c 

0.20  to  0.60  C.  c.  .    . 

1  to  4  C.  c 

8  to  30  milligrams   . 

2  to  4  Gm 

1  to  6  milligrams     . 
4  to  8  C.  c 

0.06  to  0.50  C.  c.  .    . 

2  to  5  C.  c 

0.30  to  2  C.  c.  .  ,  . 
0.30  to  2  C.  e.   .    .    . 

4  to  12  C.  c.    .    .    . 

5  C.  c 

5C.  c 

4  to  32  C.  c.    .    .    . 

0.30  to  I  C.  c.   .    .    . 

10  to  25  C.  c.    .    .    . 

0.30  to  I  C.  c.  .    .    . 

4  to  32  C.  c.    .    .    . 

4  to  8  C.  c 

5  to  12  centigrams  . 

6  to  60  centigrams  . 
I  to  2  Gm 

30  to  1 20  milligrams. 


Dose  in  apothecaries' 
weights  or  measures. 


^2  to  2  fl.  drachms. 
I  to  10  minims. 
5  to  30  minims. 
8  to  75  minims. 

5  to  15  minims. 
8  to  30  minims. 

^  to  2  fl.  drachms. 

I  to  8  fl.  drachms. 
15  to  60  minims. 
8   to  60  minims. 
^2  to  2  fl.  drachms. 

8  to  15  minims. 

6  to  15  minims. 
8  to  30  minims. 

1  to  2  fl.  drachms. 
^  to  2  fl.  drachms. 
^  to  2  fl.  drachms. 

3  to  10  minims. 
15  to  60  minims. 
yiio  Yi  grain. 
^  to  I  drachm. 
?V  ^o  To  grain. 

I  to  2  fl.  drachms. 

I  to  8  minims. 
30  to  75  minims. 

5  to  30  minims. 

5  to  30  minims. 

I  to  3  fl.  drachms. 

I  fl.  drachm. 

I  fl.  drachm. 

I  to  8  fl.  drachms. 

5  to  15  minims. 

3  to  6  fl.  drachms. 

5  to  15  minims. 

I  to  8  fl.  drachms. 

I  to  2  fl.  drachms. 

I  to  2  grains. 

I  to  10  grains. 
15  to  30  grains. 
_J^  to  2  grains. 


The  Best  Twenty-five  Drugs. — It  is  claimed  that  the 
medical  art  could  be  carried  on  with  the  following  drugs, 
twenty-five  in  number,  and  which  represent  the  soul  of  the 
Pharmacoprjeia:  i,  opium;  2,  mercury;  3,  iodides;  4,  quinine; 
5,  chloroform;  6,  ether;  7,  sulphate  of  magnesia;  8,  salicylic 
acid;    9,   aloes;     10,   alcohol;     11,  bromides;    12,  iron;    13, 


104  DENTAL   MEDICINE. 


chloral;   14,  castor-oil ;   15,  digitalis  ;    16,  arsenic;    17,  colchi- 

cum  ;   18,  ip^ecac;   19,  aconite;  20,  strychnia ;  21,  cocaine;  22, 

ergot;    23,  bicarbonate   of  potash;    24,  mineral   acids;    25, 

nitrites. 

POISONS. 

SYMPTOMS    AND   ANTIDOTES. 

Cases  of  poisoning  require  the  prompt  administration  of 
remedies,  and  hence  a  knowledge  of  the  usual  antidotes  is 
requisite,  in  order  that  they  may  be  employed  with  effect. 

For  the  majority  of  such  cases,  the  chief  reliance  must  be 
upon  emetics,  so  that  free  vomiting  may  be  induced  by  such 
articles  of  this  class  which  are  most  speedy  in  their  effect. 
Sulphate  of  zinc  is  preferable  to  many,  and,  if  vomiting  is 
present,  it  may  be  aided  by  diluents  or  a  vegetable  emetic. 
When  the  poisonous  substance  has  remained  for  any  length  of 
time  in  the  stomach,  the  use  of  emetics  will  not  prove  suffi- 
cient, but  resort  must  be  had  to  the  stomach-tube  and  syringe. 
Milk*  lime  water,  soap,  or  solutions  of  sugar  or  honey  will 
protect  the  stomach  and  intestines,  while  oil  and  other  fatty 
matters  may  prove  injurious.  Carbonate  of  magnesia  with 
tincture  of  opium,  suspended  in  water,  freely  administered, 
will  prove  very  serviceable  after  the  vomiting  has  ceased,  and 
the  patient  is  suffering  from  retching  and  pain. 

When  the  nature  of  the  poison  is  unknown,  a  general  anti- 
dote, consisting  of  equal  parts  of  calcined  magnesia,  pulverized 
charcoal,  and  hydrated  peroxide  of  iron,  which  are  to  be 
diffused  in  water,  may  be  freely  administered,  and  will,  in  the 
majority  of  cases,  prove  efficient,  as  one  or  another  of  them  is 
an  antidote  to  most  of  the  mineral  poisons. 

The  albumen  of  eggs  and  tannic  acid  are  also  considered 
to  be  valuable  antidotes.  The  albumen  neutralizes  corrosive 
sublimate  and  like  salts,  and  the  tannic  acid  precipitates  all  of 
the  vegetable  alkaloids  as  tannates, 

ACIDS  {Mineral). 

Symptoms. — Corrosion  of  parts  with  which  the  acid  comes 
in   contact,  with  an  immediate  burning  pain  in  the    mouth, 


POISONS.  105 

throat,  oesophagus  and  stomach  ;  vomiting  of  Hquid  impreg- 
nated with  mucus  and  blood.  Death  occurs  from  inflamma- 
tion, or  from  asphyxia. 

Antidotes. — Chalk;  magnesia;  solution  of  carbonate  of  soda; 
emollient  drinks  ;  fixed  oil  and  fatty  matter  ;  plaster  off  wall, 
in  emergency. 

ACONITE. 

Symptoms. — Numbness  and  tingling  of  the  mouth  and 
throat,  followed  by  vomiting  and  purging ;  giddiness  ;  feeble 
pulse;  dilated  pupil ;  oppressive  breathing;  paralysis.  Death 
occurs  from  syncope  or  apnoea. 

Antidotes — Emetics  ;  stimulants,  external  and  internal,  such 
as  sulphate  of  zinc,  tannic  acid,  animal  charcoal,  atropine, 
belladonna. 

ALKALIES  {See  Potash). 
ANTIMONY  (Tartar  Emetic,  Butter  of  Antimony). 

Symptoms. — A  burning  pain  in  stomach  and  bowels  ;  vomit- 
ing ;  purging  ;  cold  perspiration ;  great  thirst ;  cramps  ;  great 
debility,  and  death. 

Antidotes. — Vegetable  acids,  such  as  tannic  acid,  catechu, 
nutgalls,  white  oak  bark,  kino,  cinchona. 

ARSENIC. 

Symptoms. — Faintness  and  nausea,  with  burning  pain  in  the 
epigastrium;  vomiting;  purging,  or  diarrhoea;  thirst;  con- 
striction in  the  throat;  feeble  action  of  the  heart,  with  a  quick 
and  weak  pulse  ;  painful  and  hurried  respiration  ;  cold  and 
clammy  skin.  Death  occurs  from  collapse,  and  sometimes 
with  convulsions. 

Antidotes. — Freshly  precipitated  hydrated  sesquioxide  of 
iron  (made  by  adding  magnesia  to  any  iron  solution);  animal 
charcoal;  ammonia;  lime  water;  stomach-pump;  artificial 
respiration  ;  cold  affusion  ;  emetics  ;  milk  ;  raw  eggs. 

ARGENTI  NITRAS  (Nitrate  of  Silver). 

Symptoms. — Corrosion  of  parts  ;  sometimes  nausea  and 
vomiting  and  convulsions  ;  paralysis. 

Antidotes. — Solution  of  common  salt  in  demulcent  drinks  ; 
albumen. 


106  DENTAL   MEDICINE. 


ATROPINE. 

Symptoms. — Insatiable  thirst,  with  dryness  of  mouth  and 
throat ;  nausea ;  giddiness  ;  palpitation  of  heart ;  intensely  di- 
lated pupil,  coma  and  death. 

Antidotes. — Emetics ;  sulphate  of  copper  (gr.  x) ;  cold  to 
head ;  ammonia,  externally  and  internally ;  opium ;  animal 
charcoal;  calabar  bean;  stimulants;  subcutaneous  injection  of 
morphia;  mustard  flour  in  water  :  cold  to  head. 

BELLADONNA. 

Symptoms. — Same  as  those  of  atropine. 
Antidotes. — Same  as  for  atropine. 

CANNABIS  INDICA  (Indian  Hemf). 

Symptoms. — Temporary  insanity,  as  shown  by  a  singular 
gait,  a  constant  rubbing  of  hands,  and  other  strange  actions, 
a  peculiar  and  cunning  appearance  of  the  eyes,  great   hunger. 

Antidotes. — Hot  brandy  and  water-  vegetable  acids,  such  as 
lemon-juice,  vinegar,  etc;  blisters  to  nape  of  neck  ;  indulgence 
in  sleep. 

CANTHARIDES. 

Symptoms. — A  burning  pain  in  stomach  ;  vomiting  and 
purging;  blood-stained  urine;  pain  in  loins,  strangury ;  pria- 
pism ;  convulsions ;  death. 

Antidotes. — Emetics  ;  emollient  or  mucilaginous  drinks ; 
opiates  by  mouth  and  rectum ;  venesection,  if  necessary. 

CARBOLIC  ACID. 

Symptoms. — When  taken  internally,  it  causes  pain  in  the 
stomach  ;  a  whitened  and  shriveled  appearance  of  the  mucous 
membrane  of  the  lips,  mouth  and  throat;  sometimes  vomiting; 
contracted  pupils ;  stertorous  breathing ;  coma,  and  death 
within  a  period  of  from  five  to  ten  minutes  to  eight  or  ten 
hours,  according  to  the  quantity  of  the  acid  swallowed. 

Antidotes. — Olive  oil;  castor  oil;  lime  water;  saccharate  of 
lime;  precipitated  carbonate  of  lime;  albuminous  and  mucila- 
ginous substances;  any  soluble  sulphate  such  as  magnesia. 

CHLORINE  WATER. 

Symptoms. — Irritation  of  air  passages ;  burning  pain  in  the 
throat  and  stomach ;  vomiting  of  bloody  mucus. 
A?itidotes. — Albumen  ;  white  of  egg ;  milk ;  flour. 


POISONS.  107 

CHLORAL. 

Symptoms. — Excitement;  delirium;  flushed  face;  cramps  in 
limbs ;  eyes  closed ;  profound  unconsciousness ;  stertorous 
breathing;  increasing  feebleness;  lividity  of  countenance;  loss 
of  pulse;  pallor;  coldness  of  extremities;  muscular  relaxation ; 
death  from  cardiac  syncope. 

Antidotes. — Nitrite  of  amyl,  when  the  poison  has  been  taken 
in  large  quantity ;  strychnia,  when  the  action  of  the  poison  is 
slow  and  culminative.  According  to  some  authorities,  picro- 
tine,  ^  gr.,  sufficient  for  30  grs.  of  chloral ;  coffee. 

CHLOROFORM. 

Symptoms. —  Drowsiness;  insensibility;  stertorous,  rapid 
breathing ;  weak  pulse ;  dilatation  of  pupils ;  relaxation  of 
muscles  ;  coldness  of  surface  ;  increasing  feebleness  of  pulse  ; 
heart  ceasing  its  action. 

Antidotes. — Fresh  air;  artificial  respiration  (inclining  head 
down,  tongue  pulled  forward),  cold  water  dashed  over  face  and 
chest;  galvanism  to  pneumogastric  and  through  diaphragm 
(one  pole  may  be  applied  to  nape  of  neck  and  the  other  to  the 
pit  of  the  stomach) ;  brandy  and  ammonia  enemata;  hypoder- 
mic injection  of  15  TTL  of  tincture  of  digitalis,  and  ^  gr.  of  atro- 
pine, or  hypodermic  injection  of  i  drachm  of  ether;  inhala- 
tion of  nitrite  of  amyl ;  tracheotomy. 

CONIUM  {Hemlock). 

Symptoms. — Thirst ;  dryness  of  throat ;  delirium  ;  convul- 
sions ;  coma  and  death,  resulting  from  paralysis  of  the  respira- 
tory muscles. 

Antidotes. — Emetics,  followed  by  demulcent  drinks,  internal 
and  external  stimulants,  as  brandy  ;  ammonia ;  coffee,  if  coma 
is  present ;  tannic  acid ;  animal  charcoal. 

CORROSIVE  SUBLIMATE. 

Symptoms. — Heat  and  pain  of  a  burning  nature  in  mouth, 
and  throat,  and  stomach  ;  nausea  ;  vomiting  of  bloody  mucus; 
diarrhoea;  dysentery;  cramps;  convulsions;  coma  and  death. 

Antidotes. — Albumen  ;  milk  ;  white  of  egg  (white  of  i  ^^<g 


108  DENTAL   MEDICINE. 


to  every  4  grs.  of  corrosive  sublimate  taken) ;  flour ;  perchlo- 
ride  of  tin ;  iron  and  zinc  (iron  filings  2  parts  and  zinc  i  part) ; 
emetics,  stomach-pump. 

CREASOTE  {See  Carbolic  Acid). 
CROTON  OIL. 

Symptoms. — Irritation  of  mucous  membrane;  burning  pain 
along  course  of  alimentary  tract ;  excessive  purging ;  inflam- 
mation of  stomach  and  intestines. 

Antidotes. — Emetic  of  sulphate  of  copper,  10  grs.,  followed 
by  mucilaginous  fluids  containing  opium,  to  allay  the  pain  ; 
olive  oil ;  opium. 

SULPHATE  OF  COPPER. 

Symptoms. — Metallic  taste  ;  eructations ;  violent  emesis  and 
purging ;  cramps  in  limbs  ;  griping  pains ;  headache ;  giddi- 
ness ;  convulsions ;  coma  and  death,  with  symptoms  of  a  dis- 
ordered condition  of  the  nervous  system. 

Antidotes. — Albumen  or  white  of  &^^ ;  yellow  prussiate  of 
potash  or  soap. 

DIGITALIS. 

Symptoms. — Nausea  ;  vomiting ;  purging ;  feeble  or  slow 
and  irregular  pulse;  dilated  pupils;  excessive  debility;  stupor; 
convulsions  ;  coma  and  death. 

Antidotes. — Recumbent  posture  after  the  use  of  such  emetics 
as  sulphate  of  zinc;  stimulate  internally  and  externally;  tannic 
acid;  animal  charcoal;  tincture  of  aconite. 

HYDROCYANIC  ACID. 

Symptoms. — Dilated  pupils  ;  spasmodic  breathing ;  convul- 
sions ;  insensibility;  fixed  eyes;  spasmodic  closure  of  jaws ; 
very  feeble  pulse  and  speedy  death. 

Antidotes. — Fresh  air  and  artificial  respiration,  with  cold 
affusion  upon  head  and  neck ;  freshly  precipitated  oxide  of 
iron,  with  an  alkaline  carbonate,  such  as  carbonate  of  ammonia ; 
chlorine;  ammonia  by  inhalation  and  injection  in  vein  of  leg. 

HYOSCYAMUS. 

Symptoms. — A  feeling  of  giddiness,  followed  by  delirium ; 
dilated  pupils  ;  fullness  about  the  head ;  drowsiness  ;  cold  per- 
spiration ;  paralysis  ;  exhaustion ;  death. 

Antidotes. — Stomach  pump;  emetics;  stimulants,  external 
and  internal ;  lemon  juice;  strong  coffee. 


POISONS.  109 

IODINE. 

Symptoms. — In  extreme  cases,  violent  vomiting  and  purg- 
ing ;  fever  and  excessive  thirst;  palpitation  of  heart;  cramps  ; 
small  and  frequent  pulse ;  occasional  dry  cough ;  and  when 
death  ensues,  it  is  probably  due  to  gastro-enteritis.  In  exces- 
sive doses,  it  acts  as  an  irritant  poison,  giving  rise  to  such 
symptoms  as  restlessness ;  burning  sensation ;  palpitation ; 
violent  priapism ;  frequent  pulse ;  excessive  thirst ;  extreme 
diarrhoea ;  trembling ;  extreme  emaciation,  and  sometimes 
syncope. 

Antidotes. — Emetics  and  demulcent  drinks ;  starch  or  flour 
diffused  in  water  ;  albumen  ;    milk  ;    opium  and  external  heat. 

LEAD  SALTS. 

Symptoms. — A  dry  and  constricted  throat ;  pain  in  stomach 
and  bowels ;  colic  ;  paralysis  of  extensor  muscles  ;  apoplectic 
symptoms. 

Antidotes. — Any  soluble  sulphate,  either  magnesia  or  soda  ; 
Epsom  salts,  followed  by  emetics,  and  afterwards  opium  and 
milk  ;  iodide  of  potassium. 

MORPHINE  {See  Opium). 
MERCURY. 

When  in  the  form  of  the  bichloride  (corrosive  sublimate), 
or  nitrate  of  mercurj',  see  corrosive  sublimate. 

NUX  VOMICA. 

Symptoms. — Spasmodic  twitching  of  muscles  ;  violent  move- 
ment of  limbs  ;  tetanic  spasms  ;  dyspnoea  ;  death. 

Antidotes. — Thirty  grains  of  chloral  and  60  grains  of  bromide 
of  potassium.     Nitrite  of  amyl. 

OPIUM. 

Symptoms. — Increasing  drowsiness ;  giddiness  ;  stupor ;  in- 
sensibility ;  stertorous  breathing ;  feeble  pulse ;  contracted 
pupil ;  coma  ;  convulsions  ;  death. 

Antidotes. — Emetic  of  10  grs.  of  sulphate  of  copper ;  stomach 
pump  ;  .stimulants,  external  and  internal ;  brandy  and  coffee  ; 
artificial  respiration  ;  cold  affusion  ;  ammonia  to  nostrils  ;  en- 


110  DENTAL   MEDICINE. 


forced   exertion  ;  galvanic  shocks  ;   belladonna  ;  tannic  acid ; 
animal  charcoal ;  atropine  hypodermically. 

OXALIC  ACID. 

Symptoms. — Burning  pain  in  throat,  oesophagus  and  stom- 
ach ;  vomiting  of  a  dark  green  or  black  fluid,  composed  of 
altered  mucus  and  blood. 

Antidotes. — Chalk  ;  magnesia ;  plaster  from  wall  in  emer- 
gency; lime,  not  potash  or  soda;  emetics;  stomach  pump. 

PHOSPHORUS. 

Symptoms. — Burning  pain  along  alimentary  tract ;  corrosion 
of  tissues;  vomiting  of  mucus  and  blood  ;  diarrhoea. 
Antidotes. — Sulphate  of  copper ;  emetics  and  purgatives. 

POTASH  AND  SODA  SALTS.- 

Symptoms. — Sharp,  burning  pain  of  the  mouth,  throat, 
oesophagus  and  stomach ;  corrosion ;  vomiting  of  blood  and 
mucus. 

Antidotes. — Dilute  acetic  acid;  citric  acid;  lemon  juice;  fixed 
oils  ;  demulcents ;  vinegar. 

SILVER  {Nitrate  of  Silver.) 

Symptoms. — Corrosion  of  tissues;  nausea;  vomiting;  con- 
vulsions; paralysis. 

Antidotes. — Chloride  of  sodium  (common  salt);  albumen; 
white  of  &^^. 

STRAMONIUM  {See  Belladonna). 
STRYCHNINE. 

Symptoms. — Spasmodic  action  of  muscles  (twitching) ;  jerk- 
ing of  limbs;  tetanic  spasms  ;  dyspnoea;  death. 

Antidotes. — Chloroform;  belladonna;  tincture  of  aconite; 
morphine;  8  grs.  morphine  antidote  to  i  gr.  strychnia;  extract 
of  conium ;  also  same  as  nux  vomica. 

TOBACCO. 

Syjnptoms. — Nausea;  vomiting;  violent  retching. 
Antidotes. — Emetic;  stimulants,  both  external  and  internal; 
strychnia;  external  heat. 

ZINC  SALTS. 

Symptoms. — A    burning    sensation   in    stomach;    nausea; 


THE   PULSE.  Ill 


vomiting;    anxious  countenance;    difficult  breathing;    small, 

quick  pulse;  cold  perspiration;    syncope;  convulsions;  death. 

Antidotes. — Carbonate  of  soda;    emetics;  warm  demulcent 

drinks. 

THE  PULSE. 

The  word  "pulse"  is  derived  from  the  Latin  word  pulso,  "I 
strike,"  and  denotes  the  striking  or  lifting  of  the  finger  by  the 
distending  vessel,  as  with  each  contraction  of  the  heart  blood 
is  forced  into  the  vessels. 

The  word  pulse  has  also  been  applied  to  the  appearance  of 
a  lifting  up  of  the  coverings  over  a  distending  vessel,  so  that 
this  word  "pulse"  is  applied  not  only  to  that  which  is  felt, 
but  to  that  which  is  seen. 

There  are  two  kinds  of  pulse,  the  arterial  and  the  venous. 
The  arterial  is  appreciated  mainly  by  palpitation,  the  venous 
by  inspection.  It  is  the  "arterial  pulse"  that  it  is  necessary 
to  study. 

The  "  radial  pulse"  is  the  one  usually  selected,  although  the 
"temporal  pulse"  is  also  noted  in  the  administration  of  anaes- 
thetic agents.  The  pulse  in  other  vessels  must  also  some- 
times be  observed,  as  in  the  brachial,  the  facial  in  front  of  the 
masseter  muscle,  the  posterior  tibial,  the  dorsalis  pedis,  the 
carotid  and  femoral  arteries. 

The  "  radial  pulse,"  the  one  usually  selected,  and  which,  in 
most  cases,  answers  all  the  requirements,  is  of  moderate  size, 
superficial,  and  can  be  readily  compressed  against  the  radius. 

When  the  pulse  is  to  be  observed,  the  patient  should  be 
either  sitting  or  lying  down.  The  observer  should  place  his 
index,  middle,  or  ring  finger  lightly  upon  the  pulse,  and  should 
then  appreciate  the  state  of  the  coats  of  the  artery,  and  should 
next  note  the  frequency,  the  rhythm,  the  tension,  volume  and 
force  of  the  pulse;  and,  lastly,  any  peculiarities,  if  present. 
Moreover,  the  pulse  of  one  side  of  the  body  should  always  be 
compared  with  the  other. 

It  should  also  be  remembered  that  forcible  extension  or 
flexion  of  the  forearm  will  sometimes  arrest  the  radial 
pulse. 


112  DENTAL   MEDICINE. 


In  noting  the  pulse  of  children  and  infants,  it  is  well  to 
count  the  pulse,  if  possible,  while  they  are  asleep. 

This  can  be  conveniently  done  in  the  temporal  artery. 

In  noting  the  pulse  at  the  wrist,  asleep  or  awake,  there  are 
often  involuntary  movements  of  the  arm  and  twitching  of  the 
muscles,  which  render  it  difficult  to  keep  the  finger  of  the 
observer  on  the  pulse.  This  difficulty  may  be  overcome  in  a 
great  degree  by  grasping  the  entire  hand  of  the  child,  and  then 
extending  the  index  finger  upon  the  pulse.  It  is  also  advis- 
able not  to  take  the  pulse  of  the  patient  until  some  little  time 
has  elapsed  after  the  appearance  of  the  observer.  In  health, 
changes  in  the  frequency  and  rhythm  of  the  pulse  are  often 
met  with. 

The  following  is  a  table  of  the  variations  in  the  frequency 
of  the  pulse  in  health : — 

Infant  asleep,  at  birth 140 

Infancy 120 

Child  under  5  years  of  age 100 

Youth go 

Male  adults 72-80 

Female  adults 80-85 

Old  age 70 

It  is  only  in  rare  cases  that  great  frequency  of  the  pulse  in 
health  is  met  with.  Sex  has  some  influence.  Up  to  the  7th 
year  of  age  the  frequency  is  about  the  same  in  both  sexes, 
but  later  the  female  is  from  6  to  14  beats — average  9 — greater 
than  in  the  male. 

Posture  also  affects  the  pulse.  It  is  most  frequent  in  the 
standing,  and  least  in  the  recumbent  position. 

The  pulse  of  a  man  is  twice  as  much  affected  by  change  of 
position  as  that  of  a  woman. 

When  the  pulse  is  much  increased  in  frequency,  change  in 
position  has  but  little  effect,  and  for  the  higher  numbers 
entirely  disappears.  When  the  head  is  lower  than  the  body, 
the  pulse  falls.  The  general  law  as  to  the  degree  of  frequency 
of  the  pulse,  as  affected  by  position,  is  as  follows  : — 

The  frequency  is  directly  proportionate  to  the  amount  of 
muscular  effort  required  to  support  the  body  in  different  posi- 


THE   PULSE.  113 


tions.  The  pulse  falls  in  sleep,  as  much  as  ten  beats.  Sleep- 
lessness increases  its  frequency.  On  awakening  from  sleep, 
there  is  usually  a  decided  increase  in  frequency.  Food  in- 
creases the  rate  of  the  pulse.  Mental  excitement  and  activity 
of  the  emotions  increases  the  frequency  ;  mental  depression  is 
often  accompanied  by  a  decrease.  Cold  lowers  and  heat  raises 
the  rate  of  the  pulse.  Among  other  causes  producing  an 
increase  in  the  frequency  of  the  pulse  in  health,  are  spirituous 
and  warm  drinks,  tobacco,  diminished  atmospheric  pressure. 
Among  other  causes  producing  diminished  frequency  of  the 
pulse,  besides  those  before  mentioned,  are  fatigue,  long-con- 
tinued rest,  debility  without  disease,  and  increased  atmospheric 
pressure. 

Occasionally  the  pulse  is  irregular  in  health,  but  when  it  is 
so,  it  is  usually  congenital.  Intermittency  is  not  infrequent 
in  health,  and  it  is  then  either  congenital  or  may  be  due  to  terror, 
anxiety,  grief,  mental  or  physical  fatigue,  and  old  age.  The 
intermittency  may  be  only  temporary,  or  it  may  become 
permanent;  and  if  it  becomes  very  frequent,  may  be  patho- 
logical. 

A  pulse  of  90  or  more  may  be  regarded  as  a  pulse  of 
abnormal  frequency  in  an  adult.  There  are  exceptions  to  this, 
but  they  are  rare.  If  the  pulse  is  quicker  than  the  temperature 
will  explain,  it  indicates  cardiac  weakness. 

A  pulse  that  day  by  day  progressively  increases,  the  temper- 
ature remaining  the  same,  shows  increased  cardiac  weakness. 
In  all  febrile  diseases,  a  pulse,  in  adults,  over  120  is  serious, 
and  indicates  cardiac  weakness.  A  pulse  of  130  or  140  indi- 
cates great  danger;  and  with  a  pulse  at  160,  the  patient  almost 
always  dies. 

Under  the  age  of  fifteen,  any  disease  of  the  lungs  is 
almost  invariably  accompanied  by  great  frequency  of  the 
pulse,  so  that  a  pulse  of  120  to  140  would  not  be  con- 
sidered as  so  serious  in  significance  as  if  it  occurred  in  an 
older  person. 

A  pulse  of  120  in  a  strong,  robust  patient  afTfccted  with 
pneumonia,  indicates  some  form  of  heart  disease.  When  pneu- 
8 


114  DENTAL   MEDICINE. 


monia  occurs  in  the  cachectic  or  debilitated,  the  pulse  is  usually- 
very  frequent,  often  120  to  i6o,  and  such  cases  usually  die. 
In  pericarditis  and  myocarditis,  there  is  great  frequency  of  the 
pulse,  especially  on  any  movement  of  the  patient —  1 30  to  1 60 — 
and  the  change  may  be  very  sudden.  In  acute  articular  rheu- 
matism, unaccompanied  by  any  heart  disease,  a  pulse  of  1 20 
or  more  indicates  great  danger.  In  pleuritic  effusions,  the 
pulse  may  be  very  frequent,  especially  when  there  is  displace- 
ment of  the  heart, 

RESPIRATION  AT  VARIOUS  STAGES. 

At  one  year  of  age,  per  minute 35 

"  two  years  of  age,  "        "       25 

"  puberty,  "        "      20 

"  adult  age,  "        "       18 

THERMOMETERS. 

There  are  three  different  thermometers  in  use — Fahrenheit's, 
Centigrade  and  Reaumur's — each  differing  from  the  other 
with  reference  to  the  number  of  degrees  between  the  freezing 
and  boiling  points  of  water.  In  Fahrenheit's,  zero  is  placed 
at  32  degrees  below  the  freezing  point,  while  in  the  others  zero 
marks  the  freezing  point. 

The  boiling  point  in  Fahrenheit's  is  placed  at  212  degrees; 
in  Centigrade  at  100,  and  in  Reaumur's  at  80. 

The  degrees  between  the  freezing  and  boiling  points  in  the 
instruments  are,  therefore,  respectively  180,  lOO  and  80. 

The  following  diagram  will  explain  the  variance : — 

Fahrenheit o.  32         77         122         167         212 

Centigrade 17.77       o         25  50  75  100 

Reaumur 14.22       o         20  40  60  80 

When  a  thermometer,  in  the  process  of  vulcanizing,  gives 
trouble  by  the  column  of  mercury  becoming  divided,  the  di- 
vided portion  remaining  in  the  top  of  the  tube,  the  best  method 
is  to  unscrew  the  thermometer  and  turn  it  upside  down,  and 
make  the  mercury  in  the  bulb  unite  with  the  mercury  in  the 
tube,  so  that  it  may  coalesce  perfectly.  This  is  a  better 
method  than  striking  the  thermometer  sharply  in  the  hollow 


THERMOMETERS.  II5 


of  the  left  hand,  and  thereby  risking  the  breaking  of  the  thin 
glass  tube. 

The  Clinical  Thermometer  is  employed  as  a  valuable  means 
of  diagnosis  and  prognosis.  It  is  valued  because  the  vital 
processes  can  only  be  normally  and  perfectly  performed  at 
the  temperature  of  g8}^°,  and  just  in  proportion  as  it  varies 
from  this,  either  above  or  below,  they  are  changed  or  entirely 
arrested.  This  standard  of  temperature,  98^°,  of  the  healthy 
body,  is  subject  to  slight  variations  during  the  day.  Although 
observations  show  that  the  normal  heat,  which  is  the  most 
essential  condition  of  life,  may  be  considerably  altered  by  a 
number  of  circumstances,  yet  the  variations  in  health  are 
generally  temporary  and  within  narrow  limits,  whereas  those 
which  arise  from  disease  are  persistent  during  the  continuance 
of  the  abnormal  condition.  Both  increase  and  decrease  of 
temperature  have  to  be  considered,  for  while  an  increase  of 
four  to  six  degrees  may  be  maintained  for  a  month,  and  not 
endanger  life,  a  decrease  of  but  one  degree,  if  maintained  for 
a  considerable  time,  will  result  in  death.  The  increase  in 
temperature  of  the  body  is  usually  proportionate  to  the  fre- 
quency of  the  pulse,  one  degree  corresponding  to  an  increase 
of  ten  beats  per  minute.     Thus — 

With  a  temperature  of    98°,  we  have  a  pulsation  of  60. 


99° 

70. 

100°     " 

80. 

101°     " 

90. 

102°     " 

"      100. 

103° 

"     no. 

104"     " 

"     120. 

116 


DENTAL   MEDICINE. 


TABLE  OF  ELEMENTARY  SUBSTANCES. 


T 

^ 

„• 

Elements. 

o 

I 

Atomic 
Weight. 

Equiva- 
lent. 

Elements. 

.0 
B 

Atomic 
Weight. 

Equiva- 
lent. 

Aluminum    .    . 

Al 

27 

13-5 

Molybdenum  . 

Mo 

95-5 

42.75 

Antimony .    .    . 

Sb 

120 

120 

Nickel  .... 

Ni 

58 

29 

Arsenic  .... 

As 

75 

75 

Niobium   .    .    . 

Nb 

94 

94 

Barium  .... 

Ba 

137 

68.4 

Nitrogen^ .    .    . 

N 

14.03 

14 

Berylium   .    .    . 

Be 

9 

9 

Osmium    .    .    . 

Os 

198.5 

99.25 

(Glucinum). 

Oxygen*    .    .    . 

0 

16 

8 

Bismuth     .    .    . 

Bi 

28 

28 

Palladium     .    . 

Pd 

105.7 

52.85 

Boron 

B 

II 

II 

Phosphorus  .    . 

P 

31 

31 

Bromine    .    .    . 

Br 

79-95 

79-95 

Platinum  .    .    . 

Pt 

194.4 

97.2 

Cadmium  .    .    . 

Cd 

111.8 

55-9 

Potassium     .    . 

K 

39-11 

39.11 

Caesium.    .    .    . 

Cs 

132.6 

132.6 

Rhodium  .    .    . 

Rh 

104. 1 

52.05 

Calcium.    .    .    . 

Ca 

40 

20 

Rubidium     .    . 

Rb 

85-3 

85.3 

Carbon^.    .    .    . 

C 

12 

6 

Ruthenium  .    . 

Ru 

104.2 

52.1 

Cerium  .... 

Ce 

140.2 

70.5 

Scandium     .    . 

Sc 

44 

22 

Chlorine^  .    .    . 

CI 

35-45 

35-45 

Selenium  .    .    . 

Se 

78.8 

39.4 

Chromium.    .    . 

Cr 

52.1 

26.2 

Sihcon  .... 

Si 

28.4 

14 

Cobalt    .... 

Co 

58.9 

29.45 

Silver    .... 

Ag 

107.92 

107.92 

Copper  .... 

Cu 

63-4 

31.6 

Sodium.   .    .    . 

Na 

23.05 

23.05 

Didymium    .    . 

Di 

144.6 

72.3 

Strontium .   .    . 

Sr 

87.4 

43-7 

Erbium  .... 

E 

165.9 

82.95 

Sulphur^   .    .    . 

S 

32.06 

16 

Fluorine    .    .    . 

Fl 

19 

19 

Tantalum .   .    . 

Ta 

182 

182 

Gallium .... 

G 

68.8 

34-4 

Tellurium     .    . 

Te 

128 

64 

Gold 

Au 

197.3 

197.3 

ThaUium  .    .    . 

Tl 

203.7 

203.7 

Hydrogen ,    .    . 

H 

1.007 

1.007 

Thorium  .    .    . 

Th 

233 

116.5 

Indium  .... 

In 

1 1 3-4 

56.7 

Tin 

Sn 

117. 7 

58.85 

Iodine    .... 

I 

126.85 

12685 

Titanium  .    .    . 

Ti 

48 

J     '      J 

24 

Iridium  .... 

Ir 

192.7 

96.35 

Tungsten .    .    . 

Tr 

183.6 

91.8 

Iron 

Fe 

56 

27.95 

Uranium  .    .    . 

U 

238.5 

51.3 

172.7 

119.25 

51.3 
172.7 

Lanthanum  .    . 

La 

138.5 

138-5 

Vanadium    .    . 

V 

Lead 

Pb 

206.95 

103,25 

Ytterbium     .    . 

Yb 

Lithium .... 

Li 

7.02 

7.02 

Yttrium     .    .    . 

Y 

89.8 

89.8 

Magnesium  .    . 

Mg 

24.3 

12 

Zinc 

Zn 

65-3 
90 

32.45 
45 

Manganese   .    . 

Mn 

55 

27 

Zirconium    .    . 

Zr 

Mercury     .    .    . 

Hg 

200 

99.85 

1 

iCarbon:  11.9736.    ^Chlorine:  35.370.     ^Nitrogen:  14.021.     ^Oxygen:  15.9633.     ^  Sulphur: 
31.984. 


CHEMICALS  SOLVABLE  BY  WATER  AND  ALCOHOL.       117 


TABLE  OF  THE  SOLUBILITY  OF  CHEMICALS   IN  WATER 
AND  ALCOHOL. 

Abbreviations  ;   s.  =  soluble ;   ins.  =  insoluble  ;    sp.  =  sparingly  ;   v.  =  very  ;    aim.  =  almost ; 
dec.  =  decomposed. 


CHEMICALS. 


One  part  is  soluble  in  : 

Acidum  arseniosum  .... 
Acidum  benzoicum  .... 

Acidum  boricum 

Acidum  carbolicum  .... 
Acidum  chromicum  .... 

Acidum  citricum 

Acidum  gallicum  .  .  .  .  . 
Acidum  salicylicum  .... 

Acidum  tannicum 

Acidum  tartaricum    .... 

Alumen 

Alumen  exsiccatum  .... 
Ammonii  carbonas    .... 

Ammonii  nitras 

Ammonii  valerianas  .... 
Antimonii  et  potassii  tartras 
Argenti  cyanidum     .... 

Argenti  iodium 

Argenti  nitras 

Argenti  nitras  fusus  .... 

Argenti  oxidum 

Atropina 

Atropinae  sulphas 

Bismuth  subnitras  .  .    .    .    . 

Bromum 

Calcii  bromidum 

Calcii  carbonas  praecipitatus 

Calcii  chloridum 

Calcii  hypophosphis  .... 
Calcii  phosphas  praecipitatus 

Calx 

Camphora  monobromata     . 

Chloral 

Cinchonidinae  sulphas  .    .    . 

Cinchonina 

Cinchonina;  sulphas  .... 

Codeina 

Creta  praeparata    .... 

Cupri  acetas 

Cupri  sulphas 

Ferri  chloridum 

Ferri  citras 


WATER. 

ALCOHOL. 

At  15°  C. 
(50°  F.) 

Boiling. 

At  15°  C. 
(5°°  F.) 

Boiling. 

Parts. 

Parts. 

Parts. 

Parts. 

30.80 

15 

sp. 

sp. 

500 

15 

3 

I 

25 

3 

15 

5 

20 

.     . 

V.  s. 

V.  s. 

V.    S. 

V.  s. 

dec. 

dec. 

0.75 

0.5 

I 

0.5 

100 

3 

4.5 

I 

450 

14 

2.2 

V.  s. 

6 

V.  s. 

0.6 

V.  s. 

0.7 

0.5 

2.5 

0.2 

10.5 

ins. 

0-3 

ins. 

20 

ins. 

0.7 

ins. 

4 

dec. 

dec. 

dec. 

0.5 

V.  s. 

20 

3 

V.  s. 

V.  s. 

V.  s. 

V.  s. 

17 

3 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

UlS. 

ins. 

ins. 

ins. 

0.8 

0.1 

26 

5 

0.6 

o-s: 

25 

5 

V.  sp. 

V.  sp. 

ins. 

ins. 

600 

35 

V.  s. 

V.  s. 

0.4 

V.  s. 

6.5 

V.  s. 

ins. 

ins. 

ins. 

ins. 

33 

.    . 

dec. 

dec. 

0.7 

V.  s. 

I 

V.  s. 

ins. 

ins. 

ins. 

ins. 

1-5 

V.  s. 

8 

1-5 

6.8 

6 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

750 

1300 

ins. 

ins. 

aim.  ins. 

aim.  ins. 

V.   s. 

V.  s. 

V.  s. 

V.  s. 

V.  s. 

V.  s. 

100 

4 

71 

12 

aim.  ins. 

aim.  ins. 

no 

28 

70 

14 

6 

1-5 

80 

17 

V.  s. 

V.  s. 

ins. 

ins. 

ins. 

ins. 

15 

5 

135 

14 

2.6 

0.5 

ins. 

ins. 

V.  s. 

V.  s. 

V.   s. 

V,  s. 

s. 

V.   s. 

ins. 

ins. 

118 


DENTAL   MEDICINE. 


TABLE  OF  THE  SOLUBILITY  OF  CHEMICALS  IN  WATER  AND  ALCOHOL. 

(Continued.) 


CHEMICALS. 


One  part  is  soluble  in: 

Ferri  lactas 

Ferri  sulphas 

Ferri  valerianas 

Hydrargyri  chloridum  corrosivum 
Hydrargyri  chloridum  mite     .    .    , 

Hydrargyri  cyanidum 

Hydrargyri  iodidum  rubrum  .  .  . 
Hydrargyri  iodidum  viride  .  .  .  . 
Hydrargyri  oxidum  flavum  .  .  . 
Hydrargyri  oxidum  rubrum  .  .  . 
Hydrargyrum  ammoniatum    .    .    . 

HyoscyamincC  sulphas 

Iodoform 

lodum 

Magnesia 

Magnesii  carbonas 

Magnesii  sulphas 

Magnesii  sulphis 

Mangani  oxidum  nigrum     .    .    .    . 

Mangani  sulphas 

Morphina 

Morphinae  acetas 

Morphinas  hydrochloras 

Morphinse  sulphas 

Phosphorus     

Piperina 

Plumbi  acetas 

Plumbi  carbonas 

Plumbi  iodidum 

Plumbi  nitras 

Plumbi  oxidum 

Potassa 

Potassii  acetas 

Potassii  bicarbonas 

Potassii  bichromas 

Potassii  bitartras 

Potassii  bromidum 

Potassii  carbonas 

Potassii  chloras 

Potassii  citras 

Potassii  cyanidum 

Potassii  ferrocyanidum 

Potassii  hypophosphis 

Potassii  iodidum 

Potassii  nitras     . 


WATER. 

ALCOHOL. 

At  15°  C. 
(50°  F.) 

Boiling. 

At  I5°C. 
(50°  F.) 

Boiling. 

Parts. 

Parts. 

Parts. 

Parts. 

40 

12 

aim.  ins. 

aim.  ins. 

1.8 

0-3 

ms. 

ins. 

ins. 

dec. 

V.   s. 

V.   s. 

16 

2 

2 

1.2 

ms. 

ms. 

ms. 

ins. 

12.8 

3 

15 

6 

aim.  ins. 

aim.  ins. 

130 

15 

aim.  ins. 

aim.  ins. 

ms. 

ins. 

ms. 

ms. 

ins. 

ins. 

ms. 

ms. 

ins. 

ms. 

ms. 

ms. 

ins. 

ins. 

V.  s. 

V.   s. 

V.   s. 

V.  s. 

ms. 

ms. 

80 

15 

sp. 

II 

aim.  ins. 

aim.  ins. 

ms. 

ins. 

aim.  ins. 

aim.  ins. 

ins. 

ins. 

0.8 

0.15 

ins. 

ins. 

20 

19 

ins. 

ins. 

ms. 

ms. 

ins. 

ins. 

0.7 

0.8 

ms. 

ins. 

V.  sp. 

500 

TOO 

36 

12 

1-5 

68 

14 

24 

0.5 

63 

31 

24 

0.75 

702 

144 

ms. 

ms. 

V.  sp. 

V.  sp. 

aim.  ins. 

aim.  ins. 

30 

I 

1.8 

0.5 

8 

I 

ms. 

ins. 

ins. 

ins. 

2000 

200 

V.  sp. 

V.  sp. 

2 

0.8 

aim.  ins. 

aim.  ins. 

ms. 

ms. 

ins. 

ins. 

0.5 

V.  s. 

2 

V.  s. 

0.4 

V.  s. 

2.5 

V.  s. 

3-2 

dec. 

aim.  ins. 

aim.  ins. 

10 

1-5 

ins. 

ins. 

210 

15 

V.  sp. 

V.  sp. 

1.6 

I 

200 

16 

I 

0.7 

ins. 

ins. 

16.5 

2 

V.  sp. 

V.  sp. 

0.6 

V.  s. 

V.  sp. 

V.  sp. 

2 

I 

sp. 

sp. 

4 

2 

ins. 

ins. 

0.6 

03 

7-3 

3.6 

0.8 

0.5 

18 

6 

4 

0.4 

aim.  ins. 

aim.  ins. 

CHEMICALS  SOLVABLE  BY  WATER  AND  ALCOHOL.       119 


TABLE  OF  THE  SOLUBILITY  OF  CHEMICALS  IN  WATER  AND  ALCOHOL. 

(Continued.) 


CHEMICALS. 


WATER. 

ALCOHOL. 

At  .5°  C. 
(50°  F.) 

Boiling. 

At  15°  C. 
{50°  F.) 

Boiling. 

Parts. 

Parts. 

Parts. 

Parts. 

20 

3 

dec. 

dec. 

9 

4 

ins. 

ins. 

0.7 

0.5 

aim.  ins. 

aim.  ins. 

100 

7 

8 

V,  s. 

1600 

700 

6 

2 

10 

V.  s. 

32 

V.  s. 

34 

I 

3 

V.  s. 

740 

30 

65 

3 

100 

40 

5 

I 

0-5 

0.2 

175 

28 

7 

I 

ins. 

ins. 

28 

0.7 

30 

2 

1-7 

0.8 

V.  s. 

V.  s. 

3 
12 

I 
dec. 

30 
ins. 

2 

ins. 

16 

0.5 

ins. 

ins. 

1.6 

0.25 

ins. 

ins. 

I.I 

2.8 

0.5 

2.5 

40 
aim.  ins. 

43 
aim.  ins. 

I 

0.12 

30 

I 

1-5 

0.5 

ins. 

ins. 

0.6 

0.3 

1.8 

1.4 

1-3 

0.6 

sp- 

40 

2.8 

0.4 

ins. 

ins. 

4 

6700 

10 

0.9 
25000 
2 

sp. 

no 

60 

sp, 

12 

2 

ins. 

ins. 

ins 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

1200 

900 

I 

V.  s. 

V.  sp. 

V.  sp. 

3 

V.  s. 

3 

1.5 

30 

3 

ins. 

ins. 

ins. 

ins. 

V.  s. 

V.  s. 

V.  s. 

V.  s. 

V.  s. 

V.  s. 

V.  s. 

V.  s. 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

ins. 

0.6 

0-3 

ins. 

ins. 

100 

40 

One  part  is  soluble  in  : 


Potassii  permanganas  .    .    . 

Potassii  sulphas 

Potassii  tartras 

Quinidinae  sulphas    .... 

Quinina 

Quininae  bisulphas  .... 
Quininae  hydrochloras      .    . 

Quininae  sulphas 

Quininae  valerianas  .... 

Saccharum 

Saccharum  lactis 

Salicinum 

Soda 

acetas    

bicarbonas 

boras     

carbonas  

chloras  

chloridum 

hypophosphis  .... 

hyposulphis      .... 

iodidum 

nitras 

sulphas 

sulphis 

Strychnina '.    . 

Strychninae  sulphas  .... 

Sulphur  lotum 

Sulphur  praecipitatum  .  .  . 
Sulphur  sublimatum     .    .    . 

Thymol 

Veratrina 

Zinci  acetas 

Zinci  carbonas  praecipitatus 

Zinci  chloridum 

Zinci  iodidum 

Zinci  oxidum 

Zinci  phosphidum     .... 

Zinci  sulphas 

Zinci  valerianas 


Sodi 
Sodi 
Sodi 
Sodi 
Sodi 
Sodi 
Sodi 
Sodi 
Sodi 
Sodi 
Sodi 
Sodi 


120 


DENTAL   MEDICINE. 


NATURAL  DISTRIBUTION  OF  REMEDIES. 


Ammonium. 

Barium. 

Calcium. 

Aluminum. 

Antimony. 

Arsenic. 

Bismuth. 

Copper. 


INORGANIC    MATERIA    MEDICA. 

ALKALIES  AND   ALKALINE  EARTHS. 

Cerium.  Potassium. 

Lithium.  Sodium. 

Manganese. 


Bromine.  1 
Chlorine. 
Fluorine. 
Iodine.      J 


Acetic. 
Benzoic. 
Carbolic. 
Citric. 


Boric. 
Chromic. 
Hydrochloric. 
Hydrobromic. 

Acetanilid. 

Acetic  ether. 

Alcohol. 

Amyl  Nitrite. 

Antipyrin. 

Carbolic  Acid. 

Chinolin. 

Chloral  hydrate. 

Chloroform. 

Croton  Chloral. 

Ether. 

Ethyl  bromide. 


Halogens. 


METALS. 

Gold. 

Nickel. 

Iron. 

Phosphorus. 

Lead. 

Silver. 

Manganese. 

Zinc. 

Mercury. 

NON-METALS. 

Charcoal. 

Peroxide  of  Hydrogen, 

Oxygen. 

Sulphur. 

Ozone. 

ACIDS. 

Organic. 

Gallic  (pyrogallic). 

Oleic. 

Hydrocyanic. 

Salicylic. 

Lactic. 

Tannic. 

Meconic. 

Tartaric. 

Inorganic. 

Nitric  (oxalic). 

Phosphoric. 

Nitrohydrochloric. 

» Sulphuric. 

Nitrous. 

Sulphurous. 

CARBON   COMPOUNDS. 

Ethyl  iodide. 

Nitrous  ether. 

Ethylate  of  sodium. 

Nitrous  oxide. 

Ethidene  bichloride. 

Paraldehyde. 

Fuchsin. 

Petrolatum. 

Hydrocyanic  acid. 

Phenacetin. 

Todoform. 

Pyrodin. 

lodol. 

Resorcin. 

Kairin. 

Salol. 

Methylene  bichloride 

Thallin. 

Naphthol,  Naphthalin. 

Trymethylamine. 

Nitroglycerin. 

Ural  (Uralium). 

Urethran. 

REMEDIAL  AGENTS. 


121 


ORGANIC    MATERIA    MEDICA. 

Composed  of  the  Vegetable  Kingdom,  which  includes  plants  used  for  medici- 
nal purposes,  and  the  Animal  Kingdom,  as  follows : 
Cantharides. 
Castor. 
Cochineal. 
Cod  Liver  Oil. 
Albumen  and  Yelk  of  Egg. 
Formic  acid. 
Honey  and  Wax. 

CLASSIFICATION  OF  MEDICINAL  SUBSTANCES. 
In  order  to  impress  the  memory  and  facilitate  investigation, 
it  is  necessary  that  medicinal   substances  should  be  classified 
according  to  their  similarity  of  action  on  the  animal  economy, 
as  follows  : 


Ichthyol. 

Pancreatin. 

Isinglass. 

Pepsin, 

Lanolin. 

Soap. 

Lard. 

Spermaceti. 

The  Leech. 

Suet. 

Milk. 

Sugar  of  Milk 

Musk. 

r 


Neurotics,  or  those  which  have  a  special 
action  on  and  modify  the  functions  of  the 
nervous  system.     To  this  group  belong  : 


2.  EccRiTics,  or  those  which  have  a  special 
action  on  the  secretions.  To  this  group 
belong : 

3.  HiEMETics,  or  those  which  modify  the  blood. 
To  this  group  belong  : 

4.  Topical  Remedies.   To  this  group  belong : 


Hypnotics  and 

Narcotics, 

Anaesthetics, 

Antispasmodics, 

Tonics, 

Astringents, 

Stimulants, 

Sedatives, 

Spinants. 

Emetics, 

Cathartics, 

Diaphoretics, 

Diuretics, 

Blennorrhetics, 

Emmenagogues. 

Haematinics, 

Alteratives, 

Antacids. 

Irritants, 

Demulcents, 

Antiseptics, 

Disinfectants, 

Coloring  Agents, 

Anthelmintics. 


DEFINITIONS   OF   THE    VARIOUS    CLASSES    OF    REMEDIAL 

AGENTS. 

HYPNOTICS  AND  NARCOTICS. 

Hypnotics  and  narcotics  are  medicinal  substances  which 
affect  the  cerebral  and  spinal  functions  by  impairing  or  de- 
stroying nervous  action,  having  first  a  stimuJant  effect,  to 
which   their   therapeutic  efficacy  is  in  a  great   degree  due. 


122  DENTAL   MEDICINE. 


They  allay  cerebral  or  spinal  irritability,  relieve  muscular 
spasm,  and  also  pain,  and  induce  sleep.  When  administered 
to  relieve  pain,  they  are  termed  anodynes ;  to  induce  sleep, 
they  are  termed  hypnotics  or  soporifics. 

Narcotics  fulfill  two  indications,  namely  :  Exciting  and  de- 
pressing the  nervous  energy.  For  the  first,  it  is  necessary  to 
begin  with  small  doses  and  repeat  them  frequently ;  for  the 
second,  a  full  dose  must  be  given  and  not  repeated  for  a  con- 
siderable time.  On  account  of  the  system  becoming  very  soon 
habituated  to  the  action  of  narcotics,  when  it  is  necessary  to 
resort  to  their  use  for  any  length  of  time  the  amount  must  be 
constantly  increased,  in  order  to  maintain  the  same  impression. 
The  difference  between  the  susceptibility  to  their  action  when 
the  body  is  in  a  morbid  or  a  healthy  condition  should  not  be 
overlooked.  Hypnotics  diminish  the  cerebral  circulation  by 
modifying  vascular  activity. 

Under  narcotics  and  hypnotics  are  classed  such  agents  as 
opium  and  its  different  preparations,  chloral,  lactucarium,  bella- 
donna, stramonium,  hyoscyamus,  tobacco,  lobelia,  conium, 
aconite,  cannabis  indica,  humulus,  camphor,  hydrocyanic  acid, 
aconite,  alcohol,  chloroform,  digitalis,  ether,  paraldehyde, 
potassium  bromide,  sulphonal,  urethran,  zinc  bromide,  etc., 
etc. 

ANESTHETICS. 

Anaesthetics  are  medicinal  agents  which  diminish  sensibility 
and  relieve  pain.  They  are  generally  in  the  form  of  vapors  or 
gases,  applied  by  inhalation,  and  possess  the  power  of  tempor- 
arily suspending  the  general  sensibility,  being  commonly  em- 
ployed for  the  prevention  of  pain  during  surgical  operations. 
They  are  divided  into  general  and  local  anaesthetics. 

General  anaesthetics  are  agents  capable  of  producing  com- 
plete insensibility  throughout  the  entire  system.  Included  in 
this  class  are  such  agents  as  ether,  chloroform,  nitrous  oxide 
gas,  bromide  of  ethyl,  bichloride  of  methylene,  tetrachloride 
of  carbon,  bichloride  of  ethidene,  bromoform,  iodide  of  ethyl, 
tetrachloride  of  carbon,  trichlorhydrin,  etc.,  etc. 

Local  anaesthetics  are  agents  whose  action  is  limited  to  a 


REMEDIAL   AGENTS.  123 


certain  part  or  organ,  when  topically  applied,  paralyzing  the 
nerves  of  the  part,  and  temporarily  destroying  the  sensibility. 
Included  in  this  class  are  such  agents  as  absolute  ether,  rhigo- 
lene,  aconite,  pyrethrum,  atropine,  cocaine,  etc.,  etc. 

ANTISPASMODICS. 

Antispasmodics  are  medicinal  agents  which  allay  irregular 
muscular  contraction  or  spasm,  and  compose  the  irregular 
actions  of  the  nervous  system,  without  any  special  or  decided 
effect  on  the  brain.  They  are  employed  in  many  varieties  of 
mental  disturbance,  insanity,  wakefulness,  hypochondriasis, 
convulsions  from  teething,  spasms  from  general  debility,  in 
which  latter  case  an  aromatic  stimulant  of  the  circulation  and 
a  permanent  tonic  prove  beneficial.  In  hysteria,  dependent 
upon  idiopathic  or  primary  nervous  irritation,  the  use  of  anti- 
spasmodics is  indicated.  Included  in  this  class  are  such  agents  ^ 
as  asafoetida,  musk,  camphor,  valerian,  galbanum,  ammoniac, 
castor,  compound  spirit  of  ether  (Hoffman's  anodyne),  etc.,  etc. 

TONICS. 

Tonics  are  medicinal  agents  which  impart  strength  to  the 
system,  producing  a  gradual  and  permanent  increase  of  nervous 
vigor,  without  preternatural  exitement.  They  stimulate  also 
in  a  secondary  manner,  by  gradually  increasing  the  force  of 
the  circulation,  and  restoring  the  digestive  and  secretory  func- 
tions to  a  more  healthy  state,  differing,  however,  from  stimu- 
lants, in  the  more  permanent  character  of  their  effects. 

Certain  agents  of  this  class,  when  administered  in  large 
doses,  act  as  antiperiodics  in  intermittent  diseases.  Benefit 
also  results  in  the  use  of  tonics  by  alternating  them.  They 
are  divided  into  vegetable  and  mineral  tonics,  the  former  pos- 
sessing a  bitter  extractive  principle,  and  the  latter  uniting 
astringent  with  tonic  properties,  and,  in  the  case  of  prepara- 
tions of  iron,  increasing  the  red  coloring  matter  of  the  blood. 
Such  agents  as  gentian,  quassia,  calumba,  wild  cherry,  serpen- 
taria,  cinchona  and  its  alkaloid  quinine,  salix,  pepsin,  are 
examples  of  vegetable  tonics;  and  the  preparations  of  iron, 
preparations  of  copper,  preparations  of  zinc,  and  such  agents 


124  DENTAL   MEDICINE. 


as  subnitrate  of  bismuth,  sulphuric,  nitric,  muriatic  and  oxaHc 
acids,  are  examples  of  the  mineral  tonics. 

ASTRINGENTS. 

Astringents  are  medicinal  agents  which  produce  contraction 
of  the  tissues,  having  a  corrugating  power,  either  directly 
exerted  on  a  part,  or  extended  by  sympathetic  action,  and  thus 
removing  morbid  affections  arising  from  a  state  of  relaxation, 
such  as  inflammation  of  superficial  parts,  hemorrhage  and 
excessive  discharges  from  mucous  membranes.  This  class  of 
remedies  is  important  in  dental  practice,  owing  to  their  great 
efficacy  as  antiphlogistics.  Astringents  are  divided  into  vege- 
table and  'mineral,  the  former  owing  their  peculiar  property  of 
astringency  to  the  presence  of  tannic  acid,  while  the  latter 
possess  a  more  decided  astringency,  and  exert  a  sedative  action 
o-n  the  vascular  system.  In  the  treatment  of  affections  of  the 
mucous  membrane,  such  as  stomatitis,  the  object  is  to  arrest 
the  inflammatory  action,  which  is  accomplished  by  the 
power  of  the  astringent  remedies  employed  locally  to  increase 
the  tonicity  of  the  tissue,  and  to  diminish  the  calibre  of 
the  vessels  supplying  the  part  with  blood,  thus  diminishing 
the  quantity  required  for  the  production  of  the  morbid  ac- 
tion. Besides  diminishing  the  current  of  the  blood  to  the 
inflamed  part,  astringents  also  exert  an  influence  on  the 
pores  or  ducts  through  which  the  discharge  is  poured  out, 
by  diminishing  their  calibre  also.  Astringents  also  exert  an 
influence  on  morbidly  relaxed  tissues,  when  such  a  condi- 
tion results  as  the  sequelae  of  disease,  especially  in  lymphatic 
temperaments,  where  flabbiness  of  the  soft  tissues  is 
characteristic. 

Care,  however,  is  necessary  in  the  use  of  astringents,  for 
when  long  or  immoderately  used  they  may  act  as  direct  irri- 
tants, inducing  inflammation  followed  by  ulceration  and 
sloughing.  They  are  contra-indicated  for  the  arrest  of  evacu- 
ations that  are  designated  by  nature  to  relieve  a  plethoric 
state  of  the  system,  unless  such  evacuations  exist  to  an  alarm- 
ing extent.  This  class  of  remedies  can  be  readily  detected  by 
the  taste^  as  they  convey  a  sense  of  roughness  to  the  palate 


REMEDIAL   AGENTS.  125 


which  cannot  be  mistaken,  and  which  is  more  marked  in  some 
substances  than  in  others.  Such  agents  as  tannic  acid,  gallic 
acid,  nutgall,  matico,  kino,  catechu,  rhatany,  white  oak  bark, 
creasote,  saHcyHc  acid,  are  examples  of  the  vegetable  astrin- 
gents ;  while  the  preparations  of  iron  and  lead,  alum,  sulphuric 
and  nitric  acids  are  examples  of  the  mineral  astringents.  (See 
Styptics. ) 

STIMULANTS. 

Stimulants,  also  known  as  excitants  and  hyper  sthenics,  are 
medicinal  substances  capable  of  exciting  a  temporary  and 
rapid  exaltation  of  the  organic  actions,  the  excitation  thus 
produced  being  extended  or  not  to  the  rest  of  the  system. 
Although  the  stomach  is  the  organ  generally  selected  in  med- 
ical practice  to  be  the  first  impressedby  stimulants,  on  account 
of  the  extensive  sympathy  which  exists  between  it  and  the 
rest  of  the  system,  in  dental  practice  these  agents  are  topically 
applied  to  the  mucous  membrane  of  the  mouth  as  counter- 
irritants  and  vesicants.  The  influence  of  stimulants  is  most 
apparent  in  conditions  of  morbid  depression,  whereas  in  health 
they  soon  induce  depression.  They  possess  the  power  of 
arousing  the  energies  of  the  nervous  system,  and  hence  are 
beneficial  in  many  nervous  disorders,  especially  those  of  a 
spasmodic  nature.  When  applied  to  the  gastro-intestinal 
canal  they  promote  digestion  as  stomachics,  and  when  admin- 
istered to  dispel  flatulence  they  are  known  as  carminatives. 
When  internally  administered,  it  is  for  the  most  part  advisable 
to  begin  with  small  doses,  and  increase  them  as  circumstances 
may  require.  In  some  cases,  however,  it  is  necessary  to  give 
them  freely  from  the  first.  It  is  often  requisite  to  change  the 
stimulating  substance  and  also  the  part  of  the  body  to  which 
it  is  applied ;  when  the  stomach  fails,  the  rectum  and  skin  may 
be  acted  upon  beneficially.  Topically  applied,  stimulants  irri- 
tate and  inflame  the  parts  with  which  they  come  in  contact, 
and  are  then  known  as  irritants. 

The  most  powerful  and  rapid  stimulants  are  known  as 
diffusible,  while  others  of  a  vegetable  nature,  containing  a  vol- 
atile oil,  arc  termed  aromatic.     Among  the  class  of  diffusible 


126  DENTAL   MEDICINE. 


Stimulants  are  such  agents  as  alcohol,  preparations  of  ammonia, 
arnica,  phosphorus,  etc.,  etc.  Among  the  class  of  aromatic 
stimulants  are  capsicum,  cinnamon,  black  pepper,  mace,  cloves, 
pimento,  oil  of  turpentine,  ginger,  cardamom,  calamus,  gaul- 
theria,  peppermint,  origanum,  etc.,  etc. 

SEDATIVES. 

Sedatives  are  medicinal  substances  employed  to  diminish 
the  frequency  of  the  action  of  the  circulation,  their  therapeutic 
influence  being  due,  it  is  thought,  to  a  stimulant  character. 
They  reduce  vascular  excitement,  and  while  relieving  irrita- 
bility and  irregularity  of  the  heart's  action,  their  first  effect  is 
to  restore  its  tone  and  force  when  it  is  in  a  morbidly  depressed 
condition.  Substances  known  as  refrigerants,  which  possess 
the  power  of  diminishing  febrile  heat,  allaying  thirst,  restoring 
the  secretions,  and  which  comprise  almost  all  of  the  neutral 
alkaline  salts,  are  also  included  with  sedatives.  Among  the 
class  known  as  sedatives  are  digitalis,  American  hellebore 
(veratrum  viride),  white  hellebore  (veratrum  album),  yellow 
jasmine  (gelsemium),  tartar  emetic,  nitrate  of  potassium,  etc., 
etc.  Among  the  class  known  as  refrigerants  are  borate  of 
soda,  citrate  of  potassium,  acetate  of  ammonia,  spirit  nitrous 
ether,  and  vegetable  acids. 

SPINANTS. 

Spinants  or  spastics  are  medicinal  substances  employed  to 
excite  muscular  contraction.  Vegetable  spinants  containing 
the  alkaloids  strychnia  and  brucia,  and  employed  therapeuti- 
cally in  cases  of  torpid  and  paralytic  conditions  of  the  mus- 
cular system,  are  the  most  important  of  this  class ;  also  ergot, 
which  is  employed  to  excite  muscular  contraction  of  the 
uterus.  Among  the  class  of  spinants  are  such  agents  as  nux 
vomica,  and  its  alkaloid  strychnine,  ignatia,  cotton-root  bark, 
ergot. 

EMETICS. 

Emetics  are  medicinal  substances  which  excite  vomiting, 
their  action  being  independent  of  any  effect  arising  from  the 
quantity  of  the  agent   introduced  into  the  stomach. 


REMEDIAL  AGENTS.  J  27 


While  the  action  of  an  emetic  is  local  as  regards  the  stomach, 
it  extends  to  almost  every  organ  of  the  body,  and  in  order  that 
a  substance  of  this  kind  shall  produce  its  effect  upon  the 
stomach,  it  must  first  make  an  impression  upon  the  cerebro- 
spinal axis.  Within  fifteen  or  twenty  minutes  after  an  emetic 
is  administered  there  is  experienced  a  feeling  of  distress,  re- 
laxation and  faintness,  with  a  cool,  moist  skin  and  small, 
feeble  and  irregular  pulse,  such  symptoms  increasing  until 
emesis  occurs ;  during  which  the  face  becomes  flushed,  the 
pulse  full  and  frequent,  with  an  increase  in  the  temperature  of 
the  body.  When  the  action  of  vomiting  is  over,  the  skin 
again  becomes  moist,  the  pulse  soft  and  feeble,  and  a  languid 
and  drowsy  feeling  is  experienced.  Whatever  may  be  the 
apparent  necessity  for  evacuating  the  stomach,  all  the  circum- 
stances of  the  case  must  be  considered,  and,  especially  if  there 
be  much  arterial  excitement,  with  determination  to  the  head, 
blood-letting  should  sometimes  be  premised. 

When  the  full  dose  of  an  emetic  is  requisite,  as  in  cases  of 
poisoning,  the  object  is  to  evacuate  the  contents  of  the  stomach 
as  speedily  as  possible  ;  but  in  other  cases  it  is  better  to  admin- 
ister the  emetic  substance  in  divided  doses,  frequently  repeated, 
until  the  desired  effect  is  produced. 

In  cases  of  torpor  or  congestion,  it  is  sometimes  necessary 
to  arouse  the  system  by  retching  or  vomiting,  which  may  be 
done  by  administering  the  emetic  with  only  a  small  quantity 
of  fluid;  but  when  the  object  is  to  empty  the  stomach  and 
duodenum  merely,  free  draughts  of  tepid  water  or  weak  chamo- 
mile tea  may  be  given  as  soon  as  nausea  occurs.  When  the 
excitability  of  the  stomach  is  greatly  diminished  by  a  narcotic, 
as  in  cases  of  poisoning,  it  is  necessary  to  assist  the  emetic  by 
the  addition  of  some  excitant.  Vinegar,  mustard  or  ammonia 
answer  as  excitants,  when  such  an  effect  is  caused  by  opium ; 
but  the  stomach-tube  is  the  best  resource. 

There  are  some  few  cases  where  emetics  cannot  be  employed 
with  safety,  as  in  congestion  of  the  brain,  a  great  determina- 
tion of  blood  to  the  head  dependent  upon  constitutional  causes, 
pregnancy,   hernia,  active   hemorrhage   from  the   lungs  and 


128  DENTAL   MEDICINE. 


uterus,  acute  gastritis,  etc.,  etc.;  and  if  emetics  are  allowable 
in  such  diseases  or  conditions,  it  is  in  nauseating  doses  only. 
When  they  are  used  merely  to  excite  nausea,  they  are  termed 
naiiseants. 

Emetics,  by  frequent  use,  are  prone  to  cause  an  increased 
susceptibility  of  the  stomach  to  their  action ;  hence,  persons 
of  delicate  habits  should  use  them  cautiously. 

Therapeutically,  emetics  are  employed  to  evacuate  the 
stomach  in  cases  of  poisoning,  undigested  food,  etc.,  to  expel 
foreign  substances  from  the  throat  or  oesophagus ;  to  excite 
nausea,  in  order  to  depress  the  vascular  and  muscular  systems; 
to  relieve  spasm ;  to  promote  secretion  and  excretion ;  and 
to  make  decided  impressions  in  the  forming  stages  of  certain 
fevers  and  delirium  tremens. 

To  relieve  excessive  vomiting,  resulting  from  the  use  of 
emetics,  ice  broken  in  small  pieces  and  swallowed ;  lime  water 
and  milk  (a  teaspoonful  of  each,  mixed  cold,  and  given  at 
intervals  of  15  or  20  minutes);  a  drop  of  creasote  in  a  wine- 
glass of  water  (a  tablespoonful  given  every  15  or  20  minutes); 
y2  drop  of  diluted  hydrocyanic  acid  in  syrup  and  water,  or  in 
syrup  of  wild  cherry  bark  (given  every  15  minutes);  or  in- 
fusion of  camphor  (made  with  boiling  water  and  given  cold, 
a  teaspoonful  frequently  repeated) ;  brandy  and  water  ;  clove 
or  green  tea;  an  anodyne  injection;  counter-irritant  to  the 
stomach  (as  a  mustard  plaster,  or  hot  fomentation  of  brandy 
and  clove  or  spice  plaster). 

Among  the  class  of  vegetable  emetics  are  ipecacuanha, 
sanguinaria,  mustard,  lobelia,  tobacco,  squill ;  and  mineral 
emetics,  such  as  sulphate  of  zinc,  sulphate  of  copper,  tartar 
emetic,  alum,  common  salt,  turpeth  mineral. 

CATHARTICS. 

Cathartics  or  purgatives  are  medicinal  agents  which  evacu- 
ate the  bowels,  and  are  capable  of  fulfilling  three  different  in- 
dications :  I.  Simply  to  evacuate  the  bowels.  2.  To  excite  an 
increased  discharge  from  the  mucous  coat  of  the  intestines, 
and  3.  To  stimulate  the  neighboring  viscera  and  cause  them 


REMEDIAL   AGENTS.  129 


to  secrete  a  greater  quantity  of  their  peculiar  fluids.  When 
they  produce  watery  discharges  by  stimulating  the  mucous 
follicles  and  exhalants,  they  are  termed  Jiydragogiies.  When 
given  in  overdoses  they  are  so  powerful  as  to  produce  violent 
vomiting  and  purging,  pain  in  the  abdomen,  cold  extremities 
and  a  sinking  pulse.  Several  different  cathartics  are  usually 
combined  in  one  formula,  when  it  is  desired  to  produce  all  of 
the  indications  above  referred  to.  Some  agents  of  this  class 
produce  their  effect  by  absorbing  the  acid  generated  in  the 
alimentary  canal,  thus  becoming  converted  into  a  purgative 
salt,  as  magnesia,  for  example.  Others  expend  their  principal 
force  upon  the  rectum  and  large  intestines,  and  for  this  reason 
are  advantageously  employed  in  affections  of  the  lower  bowels, 
and  the  uterus  and  its  appendages,  such  as  aloes,  for  example. 
Cathartics  should  always  be  given  on  an  empty  stomach.  If 
administered  immediately  after  a  full  meal,  they  arrest  the 
digestive  process,  are  liable  to  cause  nausea,  if  not  vomiting, 
and  do  not  evacuate  the  bowels  with  the  same  certainty  or 
effect. 

When  simple  costiveness  is  to  be  removed,  the  cathartic 
may  be  administered  in  the  evening,  and,  if  not  sufficient,  the 
dose  can  be  repeated  in  the  morning  and  at  regular  intervals 
through  the  day,  until  the  effect  is  produced. 

In  administering  cathartics,  the  excitement  is  to  be  continued 
till  the  requisite  action  is  induced,  yet  not  sufficient  to  prove 
an  irritant  But  in  the  treatment  of  many  diseases,  it  is  prefer- 
able to  purge  through  the  day,  in  order  that  the  sleep  may  not 
be  disturbed  at  night.  The  operation  of  cathartics  may  be 
very  much  accelerated  by  the  free  use  of  diluent  drinks,  such 
as  gruel,  barley  water,  etc.,  etc.  By  combining  these  remedies, 
the  action  of  many  of  them  is  modified  and  controlled ;  and 
some  of  the  more  powerful  may  be  made  to  operate  mildly 
and  certainly  by  uniting  small  quantities  of  several  of  them 
in  the  same  dose. 

The  addition  of  an  emetic  substance,  such  as  ipecacuanha, 
or  tartar  emetic,  gives  activity  to  the  combination,  while  it 
modifies  the  harshness  of  the  powerful  cathartics. 
9 


130  DENTAL  MEDICINE. 


The  operation  of  a  cathartic  may  often  be  promoted  by 
judicious  venesection,  and  if  there  is  spasm  of  the  intestines, 
opium  may  be  advantageously  added  to  the  cathartic. 

Cathartics  act  not  only  upon  the  bowels,  but  upon  distant 
parts,  as  every  portion  of  the  organism  is  capable  of  being 
impressed  by  them.  Cathartics  are  divided,  according  to  the 
intensity  of  their  operation,  into  laxatwes,  purgatives  and 
drastics,  to  which  may  also  be  added  e^iemata.  Laxatives 
gently  stimulate  the  mucous  coat  of  the  intestines,  and  hence 
they  are  well  adapted  for  cases  in  which  the  sole  indication  is 
to  unload  the  bowels  of  their  contents.  Purgatives  are  more 
powerful  in  their  operation  ;  they  excite  a  copious  exhalation 
from  the  mucous  lining  of  the  intestines,  and  augment  the 
peristaltic  action  to  a  great  degree.  Drastics  are  the  more 
powerful  and  violent  cathartics,  and  produce  a  greater  degree 
of  irritation  in  the  lining  membrane  of  the  intestines,  and 
occasionally  act  upon  the  nerves  of  the  stomach,  so  as  to  cause 
nausea  and  sometimes  vomiting.  Drastics  generally  belong  to 
the  resino-extractive  substances,  and  act  violently,  on  account 
of  being  sparingly  soluble  and  adhering  to  the  mucous  coat  of 
the  intestines. 

Enemata  are  agents  of  this  class  which  act  on  the  lower  part 
of  the  intestinal  tube  by  direct  application ;  they  irritate  the 
lining  membrane  of  the  rectum,  and  by  sympathy  of  continuity, 
their  influence  is  extended  to  the  intestinal  canal.  Hence 
enemata  may  be  employed  with  advantage  when  cathartics 
cannot  be  given  by  the  mouth,  as  when  deglutition  is  im- 
practicable. What  are  known  as  saline  cathartics  are  employed 
in  the  treatment  of  febrile  and  inflammatory  affections,  as  they 
do  not  produce  any  excitant  action  on  the  general  system. 
There  are  also  acrid  cathartics,  which  are  not  violent  enough 
to  cause  inflammation.  Others  are  known  as  mercurial  cathar- 
tics. The  class  known  as  laxatives  comprise  such  substances 
as  certain  articles  of  diet,  as  ripe  and  dried  fruits,  such  as  tam- 
arinds, peaches,  raisins,  figs,  prunes,  also  molasses,  honey, 
cracked  wheat,  Indian  meal  and  oatmeal,  etc.,  etc.  Other 
laxatives  are  castor  oil,  manna,  sulphur,  purging  cassia,  etc., 


REMEDIAL  AGENTS.  131 


etc.  Saline  cathartics  comprise  such  substances  as  magnesia, 
carbonate  and  sulphate  of  magnesia  (Epsom  salts),  solution 
of  citrate  of  magnesia,  sulphate  of  sodium  (Glauber's  salt), 
sulphate  of  manganese,  phosphate  of  sodium,  sulphate  of  po- 
tassium, cream  of  tartar,  soluble  tartar,  Rochelle  salts.  ATild, 
acrid  cathartics  comprise  such  substances  as  rhubarb,  aloes, 
senna,  leptandra,  elder.  Drastic  cathartics  comprise  such  sub- 
stances as  jalap,  may  apple,  scammony,  colocynth,  gamboge, 
elaterium,  croton  oil.  Mercurial  cathartics  consist  of  calomel, 
blue  mass,  mercury  with  chalk.  Enemata  consist  of  tepid 
water,  flaxseed  tea  or  other  demulcent  infusion  ;  a  combination 
of  a  tablespoonful  each  of  common  salt,  molasses  and  lard  or 
olive  oil,  in  two-thirds  of  a  pint  of  warm  water,  to  which  castor 
oil  or  Epsom  salt  may  be  added  to  augment  the  cathartic 
effect,  is  a  formula  for  the  common  laxative  enema.  (See  Pur- 
gatives.^ 

DIAPHORETICS. 

Diaphoretics,  known  also  as  siidorifics,  are  medicinal  sub- 
stances capable  of  producing  perspiration,  or  an  increase  of 
the  cutaneous  discharge,  which  may  be  occasioned  by  the  mere 
drinking  of  a  large  quantity  of  fluid,  provided  the  temperature 
of  the  system  be  kept  up.  The  determination  of  blood  to  the 
cutaneous  vessels  by  a  warm  temperature  or  exercise  will  pro- 
duce diaphoresis,  and  the  action  of  nauseating  agents,  by  re- 
laxing the  orifices  of  the  cutaneous  vessels,  and  also  stimulants, 
by  exciting  such  vessels  to  increased  secretion,  will  have  the 
same  effect. 

The  external  application  of  heat,  friction,  etc.,  stimulates  the 
cutaneous  capillaries  and  causes  an  increased  secretion. 

Diaphoresis  may  also  be  excited  by  medicines  which  enter 
the  circulation  and  stimulate  the  cutaneous  vessels  by  contact, 
such  as  the  mercurials  and  sulphur;  also  by  medicines  which 
act  on  the  surface  .sympathetically,  through  the  medium  of  the 
stomach,  as  cold  drinks,  etc. 

Diaphoresis  may  also  be  produced  by  increasing  the  general 
action  of  the  vascular  system,  by  such  means  as  violent  exer- 
cise, the  warm   bath,  and  by  the  u.se  of  alcohol,  ammonia, 


132  DENTAL   MEDICINE. 


guaiacum,  etc.;  it  may  also  be  produced  by  the  use  of  agents 
capable  of  relaxing  the  morbidly  constricted  mouths  of  the 
perspiratory  vessels,  such  as  the  antimonials,  saline  diaphor- 
etics, and  by  the  operation  of  venesection. 

Nauseating  diaphoretics  are  employed  to  produce  a  powerful 
relaxing  action  in  inflammatory  cases  not  complicated  with 
gastric  irritability,  and  for  such  effects  the  emetics  ipecacuanha 
and  the  preparations  of  antimony  are  administered. 

Refrigerant  diaphoretics  are  employed  to  produce  a  gentle 
relaxing  effect  in  allaying  febrile  excitement  and  reducing  the 
temperature  of  the  body, 

Stimidating  diaphoretics  are  employed  in  rheumatic  and 
pulmonary  affections,  after  vascular  excitement  has  been  re- 
duced, and  where  the  surface  is  cool,  being  contra-indicated 
in  a  high  degree  of  inflammation.  For  such  effects,  the  dif- 
fusible stimulants,  aromatic  substances,  and  such  narcotics  as 
opium  and  camphor  are  administered.  During  the  adminis- 
tration of  diaphoretics,  the  patient  should  be  confined  to  bed, 
and  when  diaphoresis  is  excited,  it  should  not  be  suddenly 
checked.  Venesection  is  generally  resorted  to  when  there  is 
great  arterial  excitement  with  undue  heat  of  skin,  before  the 
attempt  is  made  to  administer  diaphoretics. 

Belonging  to  the  class  of  diaphoretics  are  such  agents  as 
Dover's  powder,,  guaiac,  spirits  of  mindererus,  nitrate  of  po- 
tassa,  sweet  spirit  of  nitre,  etc.,  etc. 

DIURETICS. 

Diuretics  are  medicinal  substances  which  act  upon  the 
kidneys,  and  produce  an  increased  flow  of  urine. 

Remedies  of  this  class  act  immediately  and  specially  upon 
the  kidneys,  some  reaching  these  organs  by  first  passing 
through  the  blood,  without  being  decomposed,  while  others, 
on  the  contrary,  undergo  changes  in  the  first  passages,  the 
result  of  such  changes  exciting  diuresis.  The  principal  use  of 
diuretics  is  to  promote  the  absorption  of  dropsical  effusions. 
They  are  also  employed  to  correct  nephritic  disorders,  ac- 
companied with  obstructed  secretion  in  calculi  of  the  kidneys, 


REMEDIAL   AGENTS.  133 

ureters  and  bladder,  and,  as  evacuants,  to  reduce  inflam- 
mation. 

Where  there  is  great  arterial  excitement,  a  judicious  use  of 
a  lancet  is  recommended,  prior  to  the  administration  of  diu- 
retics, the  patient  being  kept  cool,  to  avoid  perspiration. 

To  insure  the  full  effect  of  diuretics,  diluent  drinks  should 
be  freely  given,  and  especially  such  as  contain  some  diuretic 
substance.  Included  in  the  class  of  diuretics  are  such  agents 
as  squill,  nitre,  cubebs,  juniper,  colchicum,  erigeron,  cream  of 
tartar,  copaiba,  podophyllum,  etc.,  etc. 

BLENNORRHETICS. 

Blennorrhetics  are  medicinal  substances  which  increase  the 
secretion  of  the  mucous  membranes,  and  are  employed  in 
morbid  conditions  of  such  membranes,  in  order  to  restore  them 
to  healthy  action,  in  cases  where  their  secretion  is  deficient, 
excessive  or  abnormal  in  quality.  They  are  termed  expectorants 
when  used  to  stimulate  the  secretion  of  mucus  from  the  bron- 
chial or  laryngeal  membranes,  as  in  bronchitis  and  laryngitis, 
and  during  convalescence,  in  pneumonia.  The  oleo-resinous 
agents  of  this  class  are  employed  in  chronic  diarrhoea,  and  the 
diarrhoea  of  typhoid  fever,  such  as  oil  of  turpentine,  for  example; 
also  in  diseases  of  the  urino-genital  mucous  membranes,  such 
as  gonorrhoea,  gleet,  leucorrhoea,  incontinence  of  urine,  cystitis, 
etc.,  etc.  Included  in  the  class  of  blennorrhetics  are  such  agents 
as  senna,  cimicifuga,  garlic,  turpentine,  squill,  copaiba,  cubebs, 
matico,  buchu,  myrrh,  benzoin,  storax,  balsam  of  peru,  balsam 
of  tolu,  etc.,  etc. 

EMMENAGOGUES. 

Emmenagogues  are  medicinal  substances  which  promote  the 
menstrual  discharge,  or  restore  it  when  entirely  suppressed. 
The  particular  emmenagogue  required  depends  upon  the  cause 
of  the  amenorrhoea ;  for  example,  when  anaemia  is  the  cause, 
the  preparations  of  iron  prove  most  effectual ;  when  from 
plethora,  blood  letting  and  cathartics  or  evacuants  are  resorted 
to  Certain  medicinal  substances  excite  the  pelvic  circula- 
tion, and  stimulate  the  parts    in    direct   connection  with   the 


134  DENTAL   MEDICINE. 


uterus,  and  thereby  increase  or  promote  the  menstrual  dis- 
charge. 

General  debility  being  the  cause  of  the  local  affection,  an 
active  administration  of  tonics,  in  connection  with  the  emmen- 
agogue  required,  is  advisable. 

The  most  prominent  of  this  class  of  emmenagogues  are 
savine,  cantharides,  ergot,  cotton  root,  Seneca  snake  root, 
guaiacum,  etc.,  etc. 

HJiMATINICS. 

Haematinics  are  medicinal  substances  which  increase  the 
number  of  blood  corpuscles,  or  the  amount  of  haematin  in  the 
blood,  and  hence,  are  administered  in  such  diseases  as  are 
dependent  on  a  deficiency  of  these  elements. 

This  class  of  remedies  includes  the  preparations  of  iron  or 
chalybeates,  which  are  capable  of  causing  changes  in  the 
condition  of  the  blood,  and  also  general  and  local  tonic 
effects. 

ALTERATIVES. 

Alteratives  are  medicinal  substances  which  are  capable, 
when  administered  in  small  doses,  of  removing  morbid  struc- 
tures and  conditions,  without  any  sensible  evacuation ;  in  other 
words,  changing,  in  some  inexplicable  and  insensible  manner, 
certain  morbid  actions  of  the  system. 

Alterative  remedies  re-establish  the  healthy  functions  of  the 
animal  economy  in  a  slow  but  decided  manner,  acting  on  the 
various  secreting  organs,  sometimes  without  any  sensible  in- 
crease of  the  secretions  themselves.  The  effect  of  minute 
doses  of  mercury,  iodine  and  other  substances,  upon  the 
glandular  apparatus,  afford  examples.  Medicinal  remedies  of 
almost  every  class  become  alteratives  by  being  administered 
in  very  small  doses,  at  intervals  of  a  few  hours ;  and  they  are 
generally  classed  with  stimulants  and  tonics,  and  some  of 
them  with  narcotics.  By  their  action  the  secretions  and  ex- 
halations are  increased ;  the  exudation  of  plastic  or  coagulable 
lymph  is  diminished;  the  formation  of  false  membranes 
checked;  the  textures  softened;  inflammatory  action  arrested; 
and  morbid  growths  and  deposits  absorbed.     Phlegmonous 


REMEDIAL   AGENTS.  135 

inflammation  is  arrested,  and  visceral  and  glandular  enlarge- 
ments are  dispelled.  But  if  administered  too  freely,  the  blood 
may  become  so  impoverished  as  to  interfere  with  the  func- 
tions of  nutrition,  and  a  marasmatic  or  cachectic  condition  be 
produced,  the  textures  being  softened,  or  even  destroyed. 
Hence  this  class  of  remedies  should  be  carefully  adminis- 
tered, and  their  effects  be  closely  observed.  The  chief  use 
of  alteratives  is  antiphlogistic  or  resolvent ;  for  example,  the 
mercurials  are  generally  employed  in  acute  inflammation,  and 
the  preparations  of  iodine  and  bromine  in  chronic  inflamma- 
tions. 

Included  in  this  class  are  the  preparations  of  mercury, 
iodine,  iodide  of  potassium,  iodoform,  bromine,  preparations 
of  arsenic,  phosphate  and  hypophosphite  of  lime,  chlorate  of 
potassium,  permanganate  of  potassium,  chlorine  water,  chlor- 
inated lime,  etc.,  etc. 

ANTACIDS. 

Antacids  are  medicinal  substances,  capable  of  neutralizing 
acidity  of  the  blood,  the  secretions,  etc.,  by  combining  with 
the  acid  and  counteracting  it. 

The  alkalies,  alkaline  earths,  and  their  carbonates  are  the 
substances  included  in  this  class,  and  the  former  are  more 
energetic  in  their  action  than  the  alkaline  earths,  such  as 
magnesia.  The  carbonates  of  these  earths  have  little  or  no 
chemical  influence  upon  the  tissues. 

This  class  of  remedies,  in  the  form  of  alkaline  preparations, 
are  administered  internally  as  antacids  in  cases  where  an  un- 
usual quantity  of  acid  is  generated  in  the  stomach — a  com- 
mon symptom  of  dyspepsia,  which  is  indicated  by  acid  eruc- 
tations, violent  heartburn  and  marked  effervescence  when  a 
carbonated  alkali  is  taken ;  the  acid  in  the  stomach  laying 
hold  of  the  alkaline  base,  and  resulting  in  a  large  quantity  of 
carbonic  acid  being  driven  off. 

Alkalies  are  also  employed  to  relieve  irritability  of  the 
stomach  and  check  vomiting  ;  also  as  antidotes  in  cases  of 
poisoning  from  acids ;  also  as  antilithics,  to  neutralize  lithic 
acid  when  it  is  separated  in   unusual  quantity  by  the  urinary 


136  DENTAL   MEDICINE. 


secretion  ;  also  as  lithontriptics,  or  solvents  of-  calculi,  more 
particularly'lithates ;  also  employed  in  cases  of  acute  rheuma- 
tism and  gout,  to  neutralize  the  excess  of  acid  in  the  blood ; 
also  in  diabetes  mellitus,  and  to  relieve  irritability  of  the  urin- 
ary organs,  cutaneous  irritation,  itching  of  the  anus,  especially 
when  such  conditions  are  dependent  on  an  excess  of  acid  in 
the  system ;  and  also  as  antiplastics  and  resolvents  in  inflam- 
mation, and  as  diuretics.  As  a  general  rule,  the  administra- 
tion of  antacids  should  be  preceded  by  an  emetic  or  cathartic, 
and  in  some  cases  both. 

When  a  permanent  effect' is  desired,  antacids  are  usually 
combined  with  tonics  and  aromatics,  and  occasionally  with 
narcotics ;  for  when  given  alone  the  relief  afforded  is  but 
transient.  To  prevent  an  irritant  and  purgative  action  on  the 
bowels,  and  also  to  facilitate  their  absorption,  antacid  prepara- 
tions are  administered  in  a  state  of  large  dilution. 

In  dental  practice  antacids  are  also  employed  for  correcting 
acidity  of  the  fluids  of  the  mouth,  often  a  result  of  acid  eructa- 
tions from  the  stomach.  The  class  of  antacids  comprise  the 
preparations  of  potassium,  sodium,  lithium,  ammonium,  mag- 
nesium and  calcium.  The  antacids  employed  in  dental  prac- 
tice are  principally  precipitated  chalk,  lime  water,  carbonate  of 
soda,  etc, 

IRRITANTS. 

The  medicinal  substances  recognized  as  irritants  are  sub- 
divided into  rubefacients y  epispastics,suppurants  and  escharotics. 

Rubefacients  are  agents  employed  to  redden  the  surface 
by  exciting  the  action  of  the  capillaries,  and  occasioning  an 
afflux  of  vascular  and  nervous  power  to  the  part  with  which 
they  come  in  contact ;  hence  pain  is  a  usual  consequence  of 
their  employment. 

They  are  used  for  the  same  purposes  as  blisters,  and  are 
often  a  good  substitute  for  them ;  for  example,  in  low  degrees 
of  inflammation,  as  local  anodynes,  as  general  stimulants  ; 
their  efficacy  as  such  depending  upon  their  action  on  the 
capillary  circulation,  and  also  on  the  pain  they  occasion.  They 
are  especially  serviceable  in  the  coma  and  asphyxia  resulting 


REMEDIAL  AGENTS.  I37 

from  poisons  and  drowning,  but  in  cases  of  cerebral  oppres- 
sion are  inferior  to  blisters.  Rubefacients  are  used  until  red- 
ness and  pain  occur,  and  their  persistent  application  will  cause 
vesication,  and  even  gangrene. 

In  the  class  of  rubefacients  are  included  mustard,  capsicum, 
oil  of  turpentine,  ammonia,  liniment.  Burgundy  pitch,  Canada 
pitch,  ginger,  black  pepper,  garlic  and  spice  plaster. 

Epispastics,  also  called  vesicants  and  blisters,  are  medicinal 
agents  capable  of  producing,  when  applied  to  the  skin,  inflam- 
mation followed  by  an  effusion  of  serum  beneath  the  cuticle 
As  a  general  rule,  blisters  should  remain  on  the  surface  of 
the  skin  six  or  eight  hours,  in  order  to  insure  their  full  effect. 
When  the  skin  is  very  delicate,  a  shorter  application  will 
answer  every  purpose ;  and  in  the  case  of  children  it  is  seldom 
necessary  for  them  to  remain  longer  than  three  or  four  hours. 
When  applied  to  the  scalp,  twelve  hours  are  generally  re- 
quired. After  removing  a  blister,  the  usual  dressing  is  some 
non-irritating  ointment,  such  as  simple  cerate.  In  aqute  dis- 
eases, blistering  ought  never  to  precede  such  means  as  have  a 
tendency  to  reduce  inflammatory  action,  and  the  application 
should  be  as  near  the  affected  part  as  possible. 

Covering  blisters  with  fine  gauze  renders  them  much  less 
irritating,  and  does  not  retard  their  operation. 

If  a  blister  is  applied  long  enough  to  redden  the  skin,  a 
simple  poultice  will  complete  the  vesication  ;  and  in  the  case 
of  children  this  method  should  always  be  pursued.  When  it 
is  necessary  to  keep  the  blister  open,  weak  epispastic  or  savin 
ointment  will  prove  sufficient.  When  the  circulation  is  lan- 
guid in  the  extremities,  they  seldom  act  efficiently,  and  may 
cause  gangrene  by  exhausting  what  vitality  remains.  When 
strangury  is  produced,  the  blister  must  be  removed  after  three 
or  four  hours,  and  the  part  bathed  with  olive  oil,  or  a  poultice 
applied,  and  diluent  drinks  used ;  an  opium  suppository  or 
injection  will  prove  serviceable.  Epispastics  are  employed  as 
local  stimulants  in  the  treatment  of  inflammation;  to  create  a 
healthy  inflammatory  action,  as  in  various  cutaneous  eruptions; 
to  relieve  pain  ;  to  destroy  morbid  associations  by  causing  a 


138  DENTAL  MEDICINE. 


powerful  impression  ;  to  stimulate  the  absorbing  or  secreting 
vessels  of  p^rts  in  the  neighborhood  of  the  affected  part ;  to 
stimulate  generally ;  to  relieve  threatened  gangrene  and  pa- 
ralysis ;  to  produce  local  depletion  as  evacuants,  and  to  prepare 
a  surface  for  the  endermic  application  of  medicines. 

The  class  of  epispastics  include  such  agents  as  cantharides, 
cantharidal  collodion,  water  of  ammonia,  etc.,  etc. 

SuppuRANTS  are  medicinal  agents,  which,  when  rubbed  on 
the  skin,  cause  rubefaction,  accompanied  by  a  pustular  erup- 
tion ;  their  beneficial  effects  being  due  to  the  counter-irritation 
set  up.  The  agents  of  this  class  are  generally  employed  in 
subacute,  chronic  laryngeal  and  bronchial  affections,  diseases 
of  the  joints,  etc.,  etc. 

Included  as  suppurants  are  croton  oil,  antimonial  ointments, 
etc. 

EscHAROTics,  called  also  Cauterants  or  Caustics,  are  medi- 
cinal agents  capable  of  destroying  the  structure  and  vitality  of 
the  parts  with  which  they  come  in  contact,  producing  an  eschar 
or  slough,  which  is  followed  by  inflammation  and  suppuration 
of  the  neighboring  tissues  to  such  a  degree  that  the  slough 
separates  from  the  living  parts.  The  mode  of  action  of  an 
escharotic  is  as  follows :  After  being  applied  to  the  skin,  so  as 
to  chemically  disorganize  it,  or  destroy  its  vitality,  a  new  action 
is  set  up  in  the  vessels  beneath  the  slough,  so  as  to  cause  it  to 
be  thrown  off.  The  excavation  resulting  is  then  kept  open  by 
inserting  some  irritant,  which  maintains  a  copious  secretion  of 
pus  from  the  ulcerated  surface.  Escharotics  are  divided  into 
Actual  and  Potential ;  the  actual  being  fire  itself,  while  the 
potential  are  substances  which  destroy  the  living  solids,  either 
by  excessive  stimulation,  or  by  producing  a  chemical  decom- 
position. 

Iron  heated  to  a  white  heat  and  the  moxa  (cones  or  cylin- 
ders of  inflammable  substance)  represent  the  actual  cautery ; 
and  caustic  potash,  nitrate  of  silver,  burnt  alum,  chloride  of 
zinc,  chromic,  sulphuric  and  nitric  acids,  and  the  nerve  or  ar- 
senical paste  employed  in  dental  practice,  represent  the  poten- 
tial cautery.     A  sub-class  is  composed  of  what  are  known  as 


REMEDIAL   AGENTS.  139 

Issues  and  Setons  :  the  blister-issue,  where  the  skin  is  removed 
by  a  blister,  and  the  discharge  promoted  by  means  of  stimu- 
lating applications,  as  the  cantharidal  ointment,  for  example ; 
also,  the  pea-issue,  where  an  incision  made  by  the  lancet  is 
kept  open  by  means  of  a  pea,  beet  or  piece  of  orris  root.  The 
Seton  is  prepared  as  follows :  A  seton  needle,  to  which  is  at- 
tached a  skein  of  silk,  is  passed  completely  through  the  part 
chosen  for  the  operation,  after  which  it  is  removed,  and  the 
ends  of  the  silk  left  hanging  from  the  wound.  It  is  dressed 
once  or  several  times  a  day  with  some  mild  ointment ;  or,  if 
this  is  not  sufficient  to  keep  up  the  discharge,  a  more  stimulat- 
ing ointment  is  used.  Escharotics  are  employed  to  destroy 
morbid  growths,  warts,  polypi,  condylomata,  fungous  granula- 
tions, etc.  ;  also  to  relieve  violent  inflammation  by  their  sub- 
stitutive action  ;  to  stimulate  indolent  ulcers,  sinuses,  etc. ;  to 
open  abscesses  of  the  liver  and  other  internal  viscera,  the 
method  of  "  aspiration"  being  preferred;  to  remove  cancer, 
lupus  and  other  morbid  growths  ;  to  decompose  the  virus  of 
rabid  and  venomous  animals,  and  of  chancres  and  malignant 
pustules,  and  prevent  their  absorption. 

Escharotics  include  such  agents  as  caustic  potassa,  fused 
nitrate  of  silver,  caustic  soda,  solution  of  nitrate  of  mercury, 
corrosive  chloride  of  mercury,  bichromate  of  potassium,  the 
mineral  acids,  sulphate  of  copper,  and  the  substances  before 
referred  to. 

DEMULCENTS. 

Demulcents,  also  called  Lenitives,  are  medicinal  substances 
which  soften  and  relax  the  tissues.  When  applied  to  irritated 
or  inflamed  surfaces  these  agents  diminish  the  heat,  tension 
and  pain.  They  consist  principally  of  gum  or  mucilage,  often 
combined  with  saccharine  or  farinaceous  substances,  and,  di- 
luted with  water,  form  viscid  solutions.  By  modifying  the 
acridity  of  the  secretions,  they  are  capable,  to  some  degree  at 
least,  of  relieving  irritation  in  remote  organs,  although  their 
constitutional  effects  are  chiefly  nutritive.  Demulcents  are 
employed  internally  to  protect  the  gastro-enteric  surface  from 
irritating  substances,  especially  poisons  of  an  acrid  nature  \ 


140  DENTAL   MEDICINE. 


also  to  relieve  irritation  and  inflammation  of  the  alimentary 
canal  in  such  affections  as  diarrhoea,  dysentery,  enteritis,  gas- 
tritis, etc.  ;  also  in  catarrhal  affections,  for  their  soothing  and 
lubricating  effects  from  direct  contact,  and  also  by  reflex  ac- 
tion ;  and  they  also  exert  some  influence  in  modifying  the 
acridity  of  expectorated  matters  ;  also  in  such  affections  of 
the  urinary  passages  as  cystitis,  ardor  urinse,  as  they  tend  to 
diminish  the  acridity  of  the  secretions  :  also  as  drinks,  to  pro- 
mote the  action  of  the  secreting  and  exhaling  organs,  and  to 
allay  the  thirst  in  fevers  ;  also  as  light  diet,  and  to  suspend 
substances  insoluble  in  water. 

Demulcents  are  employed  externally  in  the  form  known  as 
Emollients,  to  relieve  the  heat,  swelling  and  pain  of  inflamma- 
tion, wounds  and  burns;  to  hasten  suppuration,  as  deter- 
gents, to  cleanse  foul  ulcers,  and  to  promote  suppuration  from 
granulating  surfaces.  Mixed  with  water  in  the  form  of  soft 
masses,  they  are  commonly  termed  cataplasms  or  poultices, 
and  have  the  effect  of  softening  the  parts  to  which  they  are 
applied  as  vehicles  of  heat  and  moisture.  Included  in  the 
class  of  demulcents  are  such  substances  as  gum  arable,  flax 
seed,  tragacanth,  slippery-elm  bark,  sassafras  pith,  marshmal- 
low,  benne,  quince  seed,  liquorice  root,  Iceland  moss,  Irish 
moss,  starch,  arrow  root,  tapioca,  sago,  barley  glycerin,  pyr- 
oxylon,  collodion,  solution  of  gutta  percha,  honey,  animal 
fats,  such  as  lard,  in  the  form  of  cerate  (lard  2  parts,  and  white 
wax  I  part),  and  suet,  both  containing  stearine. 

ANTHELMINTICS. 

Anthelmintics,  or  Vermifuges,  are  medicinal  substances  em- 
ployed to  destroy  and  expel  worms  (entozoa)  from  the  alimen- 
tary canal.  Their  action  differs  according  to  the  nature  of 
the  substance  used,  either  to  destroy  by  a  direct  poisonous 
influence  or  by  mechanical  means.  The  most  powerful  of  the 
cathartics  (drastic)  also  act  as  anthelmintics  by  the  copious 
secretion  and  exhalation  which  they  produce  from  the  alimen- 
tary canal.  When  anthelmintics  are  employed,  they  must  be 
persevered  in  for  several  days,  with  the  occasional  intervention 
of  an  active  cathartic. 


REMEDIAL  AGENTS. 


141 


Belonging  to  this  class  are  such  agents  as  wormseed,  spi- 
gelia,  santonica,  cowhage,  male  fern,  oil  of  turpentine,  kameela, 
pumpkin  seed,  kousso,  calomel  with  gamboge,  calomel  with 
pink  root,  iron  preparations,  etc.,  etc. 

COLORING  AGENTS. 

Coloring  agents  are  substances  employed  to  communicate 
their  peculiar  color  to  pharmaceutical  preparations.  They 
include  saffron,  cochineal,  red  saunders,  etc.,  etc.;  and  in  dental 
practice  they  are  used  for  coloring  dentifrices,  such  as  rose  pink. 


In  addition  to  the  general  classes  menti 
tain  sub-classes  recognized,  which  have 
referred  to  in  the  preceding  definitions  as 


Absorbents, 

Anodynes, 

Antemetics, 

Anthridrotics, 

Antiperiodics, 

Antipyretics, 

Antiseptics, 

Aromatic  Bitters, 

Carminatives, 

Caustics, 

Cauterants, 

Constringents, 

Counter-irritants, 

Desiccalives, 


Detergents, 

Deodorizers, 

Diluents, 

Discutients, 

Disinfectants, 

Emollients, 

Errhines, 

Escharotics, 

Expectorants, 

Evacuants, 

Excitants, 

Febrifuges, 

Germicides, 

Haemostatics, 


oned,  there  are  cer- 
not  been  specially 
follows  : — 

Hypersthenics, 

Hypnotics, 

Laxatives, 

Nervines, 

Nutritives, 

Purgatives, 

Refrigerants, 

Resolvents, 

Restoratives, 

Sialogogues, 

Stimulants, 

Styptics, 

Vesicants. 


ABSORBENTS. 

Absorbents,  known  also  as  Desiccatives,  are  medicinal  agents 
capable  of  checking  secretions,  and  drying  up  secretions  or 
discharges  from  ulcers  and  suppurating  wounds.  Included  in 
this  class  are  tannic  acid,  oxide  of  zinc,  charcoal,  subnitrate  of 
bismuth,  starch,  powdered  galls,  magnesia,  powdered  myrrh, 
carbonate  of  lime,  etc.,  etc. 

ANODYNES  OR  ANALGESICS. 

Anodynes,  which,  with  sedatives,  hypnotics,  or  soporifics,  are 
included  in  the  group  of  narcotics,  are  medicinal  agents  capa- 
ble   of  alleviating   pain   by   lessening   the   sensibility  of  the 


142  DENTAL   MEDICINE. 


nerve-centres  or  the  peripheral  extremities.  When  applied 
locally  they  are  called  analgesics.  Included  in  this  class  are 
opium,  morphia,  chloroform,  sulphuric  ether,  aconite,  croton, 
chloral,  belladonna,  camphor,  gelsemium,  cannabis  indica, 
stramonium,  hyoscyamus,  carbolic  acid,  atropine,  creasote,  co- 
caine, eugenol,  iodoform,  iodol,  antipyrin,  blood-letting,  heat 
and  cold,  acupuncture,  etc.,  etc. 

ANTEMETICS. 

Antemetics  are  medicinal  agents  capable  of  arresting  vomit- 
ing. Included  in  this  class  are  creasote,  dilute,  hydrocyanic 
acid,  lime  water,  chloral,  chloroform,  magnesia,  dilute  nitric 
acid,  dilute  phosphoric  acid,  belladonna,  oxalate  of  cerium,  etc. 

ANTHRIDROTICS. 

Anthridrotics  are  medicinal  agents  capable  of  checking 
perspiration.  Included  in  this  class  are  oxide  of  zinc,  sul- 
phuric acid,  acetic  acid,  tannic  acid,  sulphate  of  iron,  haema- 
toxylon,  etc. 

ANTIPERIODICS. 

Antiperiodics  are  medicinal  agents  capable  of  relieving 
periodical  diseases,  such  as  intermittent  fevers,  neuralgia,  etc. 
Included  in  this  class  are  cinchona,  quinia,  arsenic  (in  form  of 
Fowler's  solution),  chloroform,  chloride  of  soda,  salicin,  etc. 

ANTIPYRETICS. 

Antipyretics  are  medicinal  agents  having  a  decided  power 
to  depress  the  temperature  of  the  body  during  fever,  and  con- 
trol hyperpyrexia.  Included  in  this  class  are  antifebrin,  anti- 
pyrin, quinoline  or  chinoline,  thalline,  kairine,  camphor,  euca- 
lyptol,hydroquinon,pyrodin,  resorcin,  quinine,  salicine,  thymol, 
salol,  etc. 

ANTISEPTICS. 

Antiseptics  are  medicinal  agents  capable  of  arresting  fer- 
mentative processes,  preventing  the  development  of  bacteria, 
thereby  preventing  or  arresting  the  decomposition  of  organic 
substances,  and  the  process  of  putrefaction.  When  these 
agents  are  brought  in  contact  with  disease  germs  they  destroy 
their  vitality.     Included  in  this  class  are  carbolic  acid,  creasote, 


REMEDIAL  AGENTS.  143 


salicylic  acid,  eucalyptus  oil,  iodoform,  benzoic  acid,  boracic 
acid,  pepsin,  bromine,  iodol,  hydronapthol,  peroxide  of  hydro- 
gen, bichloride  of  mercury,  essential  oils,  etc. 

Forms  of  Antiseptics  for  Use:  Dr.  Black  on  this  subject  says : 
"In  regard  to  the  use  of  antiseptics  in  different  cases  and  for 
different  purposes,  I  should  divide  them  into  three  forms,  each 
of  which  has  especial  advantages. 

"  These  forms  are :  the  solution  in  water,  the  oil,  and  the 
powder. 

"The  solution  in  water  is  especially  useful  for  cleaning  in- 
fected surfaces  of  wounds,  washing  abscesses,  and,  indeed,  in 
any  case  where  there  is  something  that  can  be  removed  by 
washing.  In  the  performance  of  this  act  the  antiseptic  is  dif- 
fused to  all  parts  of  the  wound  or  abscess  mechanically  to  the 
best  advantage.  It  is  more  likely  to  reach  every  part  in  this 
form  than  in  any  other ;  and  this  is  an  advantage  that  can 
hardly  be  over-estimated;  for  it  is  very  difficult  to  reach  all 
parts  of  an  abscess  by  any  mode  of  procedure  now  known  to 
us  on  account  of  the  very  tardy  diffusion  of  liquids.  And  in 
case  the  liquid  containing  the  antiseptic  in  solution  does  dif- 
fuse, its  very  diffusion  and  mixture  with  the  surrounding  fluids 
soon  dilutes  it  below  its  range  of  antiseptic  value.  It  is  there- 
fore necessary  that  the  washing  be  continuous  to  obtain  the 
continuous  effect  of  the  drug.  This  is  generally  impracticable, 
and  for  this  reason  the  watery  form  of  antiseptics  is  very  much 
limited  in  usefulness.  The  continuous  drip,  or  the  application 
as  often  as  every  fifteen  or  twenty  minutes,  gives  effective  re- 
sults in  some  favored  localities;  but  it  is  very  difficult  to  carry 
out  and  occasions  much  trouble.  The  continuous  bath  is 
still  more  limited  in  its  range  of  application.  Neither  of  these 
can  be  used  in  dental  practice.  With  us  the  watery  form  of 
antiseptics  should  be  limited  to  the  cleaning  of  infected  parts. 
They  cannot  be  trusted  to  prevent  septic  action  for  any  length 
of  time,  for  the  reason  that  they  so  soon  become  diluted  be- 
low their  range  of  antiseptic  value  by  mixing  with  the  secre- 
tions, or  the  juices  of  the  flesh.  Since  studying  the  powers  of 
antiseptics  and  disinfectants  more  closely,  my  feeling  is  that  it 


144  DENTAL   MEDICINE. 


will  not  do  for  us  to  expect  to  do  much  disinfectant  work  in 
connection  with  the  soft  tissues  except  in  cases  in  which  some 
tissue  destruction  can  be  borne ;  and  that  antiseptics  only  re- 
tard the  growth  of  microbes  during  their  presence  in  effective 
proportion;  hence  the  necessity  for  continuous  and  oft-re- 
peated application.  In  using  these  for  the  purpose  of  clean- 
ing, much  aid  may  be  had  by  making  use  of  the  solution  in 
peroxide  of  hydrogen  instead  of  water,  so  as  to  obtain  the 
mechanical  effect  of  the  ebullition  of  the  oxygen  evolved  in  mix- 
ing the  antiseptic  with  the  secretions.  There  is  possibly  some 
antiseptic  virtue  in  oxygen  itself  as  well,  but  I  am  apt  to  think 
that  its  principal  use  is  the  mechanical  one.  And  that  is  a 
very  important  use.  Thorough  cleaning  is  excellent  antiseptic 
work,  and  the  peroxide  of  hydrogen  will  do  this  in  many 
positions  where  nothing  else  will,  and  at  the  same  time  carry 
the  antiseptic  proper  to  the  more  remote  parts  of  the  wound 
or  abscess." 

Sir  Joseph  Lister  is  the  originator  of  the  antiseptic  treat- 
ment in  surgery.  He  first  employed  carbolic  acid  as  an 
antiseptic  for  surgical  dressings,  but  abandoned  it  on  account 
of  its  slow  action  as  a  germicide  and  its  volatility.  He  then 
employed  bichloride  of  mercury,  which  was  stable  and  acted 
promptly,  but  caused  irritation,  and  was  precipitated  by  the 
albumen  contained  in  the  serum  of  the  blood.  He  then  em- 
ployed the  sero-sublimate  gauze,  consisting  of  gauze  saturated 
with  a  solution  of  bichloride  of  mercury,  in  the  serum  of  the 
blood ;  but  this  being  harsh  and  non-absorbent  he  substituted 
for  it  a  combination  of  chloride  of  ammonia  and  chloride  of 
mercury,  known  as  sal-alembroth,  which  was  not  only  less  ir- 
ritating, but  was  soluble  in  blood  serum.  Later  he  presented 
the  double  cyanide  of  zinc  and  mercury  as  the  best  antiseptic, 
on  account  of  its  being  non-volatile,  un-irritating,  insoluble  in 
water,  and  only  soluble  in  3,000  parts  of  blood  serum,  with  an 
inhibitory  power  so  high  that  a  solution  of  1:1200  is  sufficient 
to  keep  animal  fluids  permanently  free  from  putrefaction.  The 
Listerian  method  consists  in  applying  over  the  line  of  the 
wound  six  or  eight  layers  of  the  gauze,  out  of  which  the  bi- 


REMEDIAL  AGENTS.  145 


chloride  has  been  washed  by  wringing  it  out  once  or  twice  in 
a  solution  of  i  to  20  carbolic  acid.  All  zymotic  diseases  are 
at  the  present  time  generally  attributed  to  bacteria  or  to  their 
ptomaines,  and  for  a  number  of  years  the  theory  that  all  con- 
tagious and  epidemic  diseases  are  caused  by  micro-organisms 
has  been  received  by  the  medical  profession.  Many  diseases 
are  now  regarded  as  contagious  which  were  not  so  considered 
before  the  discovery  of  bacteria.  Bacteria  are  found  in  great 
numbers  and  different  varieties  in  the  air,  earth,  water,  and  in 
every  part  of  the  body  of  man  and  animals,  and  multiply  very 
rapidly  by  division  and  by  spores.  Some  varieties  are  subject 
to  change,  others  appear  to  be  permanent.  New  varieties  are 
supposed  to  be  produced  by  the  same  laws  by  which  the  dif- 
ferent kinds  of  vegetables,  plants  and  animals  are  generated. 
The  discoveries  in  bacteriology  have  brought  about  a  revolu- 
tion in  the  treatment  of  many  diseases,  namely,  tuberculosis — 
as  the  Koch  treatment — typhoid  and  other  fevers,  carbuncle, 
erysipelas,  diphtheria,  pneumonia,  influenza,  malaria,  tetanus, 
etc.,  etc.     (See  Use  of  A?itiseptics  in  Dental  Practice.) 

AROMATIC    BITTERS. 

Aromatic  bitters  differ  from  simple  bitters  in  the  aromatic 
constituents  they  contain.  They  possess  tonic  properties  and 
invigorate  digestion  and  promote  constructive  metamorphosis. 
They  are  employed  in  the  same  cases  as  simple  bitters,  but 
appear  to  possess  some  specific  properties  due  to  the  aromatic 
constituents.  Included  in  this  class  are  serpentaria,  prunus 
virginiana,  canella,  anthemis,  etc. 

CARMINATIVES. 

Carminatives  are  medicinal  agents  capable  of  dispelling 
flatulence,  and  allaying  pain  in  the  stomach  and  bowels.  In- 
cluded in  this  class  are  such  agents  as  cinnamon,  cardamom, 
cloves,  coriander,  lavender,  juniper,  ginger,  caraway,  pepper- 
mint, etc. 

CAUSTICS. 

Caustics  are  medicinal  substances  capable  of  destroying 
vitalized  tissue.     (See  Irritants?) 


146  DENTAL   MEDICINE. 


CAUTERANTS  (See  Irritants). 

CONSTRINGENTS  (See  Astringents). 

COUNTER-IRRITANTS. 

Counter-irritants  are  medicinal  agents  which  are  employed 
to  produce  external  irritation  for  the  purpose  of  relieving  or 
curing  diseased  action  in  another  part,  as  in  periodontitis,  for 
example,  when  such  agents  as  iodine,  cantharidal  collodion, 
creasote  and  iodine,  aconite  and  iodine,  ammonia,  etc.,  etc.,  are 
applied  to  the  gum  over  the  root  of  the  affected  tooth.  (See 
Irritants) 

DESICCATIVES. 

Desiccatives  are  medicinal  agents  capable  of  checking  secre- 
tions, and  arresting  mucous  discharges  from  ulcers,  wounds, 
etc.     (See  Absorbents.) 

DETERGENTS, 

Detergents  are  medicinal  agents  capable  of  cleansing 
ulcers,  suppurating  wounds,  etc.,  by  acting  as  either  stimu- 
lants or  emollients.  Included  in  this  class  are  such  agents 
as  borax,  burnt  alum,  slippery-elm  bark,  acacia,  flax  seed, 
tragacanth,  etc. 

DEODORIZERS. 

Deodorizers  are  medicinal  agents  capable  of  destroying 
infectious  and  fetid  odors.  Included  in  this  class  are  carbolic 
acid,  salicylic  acid,  creasote,  chloride  of  lime,  charcoal,  per- 
manganate of  potash,  thymol,  chloride  of  zinc,  solution  of  chlo- 
ride of  soda,  oil  of  eucalyptus,  iodoform,  menthol,  hydrochloric 
acid,  nitric  acid,  sulphuric  acid,  etc.,  etc.     (See  Antiseptics.) 

DILUENTS. 

Diluents  are  medicinal  agents  capable  of  diluting  the  blood 
and  thus  increasing  its  fluidity ;  at  the  same  time  exercising 
a  solvent  action  and  eliminating  a  portion  of  the  solid  con- 
stituents. Included  in  this  class  are  such  agents  as  water, 
aerated  water,  mineral  waters,  rice  water,  beef  tea,  whey, 
barley  water,  gruel,  etc.,  etc. 

DISCUTIENTS. 

Discutients  are  medicinal  agents  capable  of  reducing 
and   depressing   morbid   growths,   swellings,   etc.     Included 


REMEDIAL  AGENTS.  147 


in  this  class  are  iodine,  mercury,  bromide  of  potassium, 
iodide  of  potassium,  chlorate  of  potassium,  arsenic,  colchi- 
cum,  etc.,  etc. 

DISINFECTANTS. 

Disinfectants  are  medicinal  agents  capable  of  depriving 
effluvia  of  their  morbific  properties  by  chemically  combining 
with  them.  Included  in  this  class  are  such  agents  as  chlorine, 
carbolic  acid,  carbolate  of  lime,  chloride  of  lime,  salicylic  acid, 
solution  of  chlorinated  soda,  charcoal,  creasote,  hydrochloric 
acid,  sulphuric  acid,  nitric  acid  and  chloride  of  zinc.  (See 
Antiseptics  and  Deodorizer s\ 

EMOLLIENTS. 

Emollients,  or  Protectives,  are  medicinal  agents  capable  of 
relaxing  soft  tissues,  allaying  irritation,  protecting  sensitive 
surfaces,  relieving  pain  in  ulceration  of  mucous  membrane. 
Included  in  this  case  are  glycerine,  collodion,  solution  of 
gutta  percha,  acacia,  tragacanth,  Irish  moss,  sassafras  pith, 
flax  seed,  slippery-elm  bark,  liquorice  root,  wax,  in  the  form  of 
cerate  ointment,  poultices  of  bread  and  milk,  yeast  and  flax 
seed,  and  charcoal  and  yeast  with  flax  seed,  lard,  etc.,  etc. 

ERRHINES. 

Errhines  are  medicinal  agents  capable  of  inducing  a  secre- 
tion from  the  nose.  Included  in  this  class  are  ammonia,  ipe- 
cacuanha, chlorine,  acetic  acid,  orris  root,  etc.,  etc. 

ESCHAROTICS. 

Escharotics  are  medicinal  agents  capable  of  producing  an 
eschar  or  slough,  and  are  included  among  Irritants.  (See 
Irritants.) 

EXPECTORANTS. 

Expectorants  are  medicinal  agents  capable  of  promoting 
the  excretion  of  mucus  and  other  fluids  from  the  air  passages 
and  lungs.  Included  in  this  class  are  squill,  ipecacuanha,  ben- 
zoic acid,  preparations  of  ammonia,  tartar  emetic,  balsam  of 
tolu,  myrrh,  nitrate  of  potash,  seneca,  wild  cherry  bark,  lobe- 
lia, etc.,  etc.     (See  Blennorrhetics.) 


148  DENTAL  MEDICINE. 


EVACUANTS. 

Evacuants  belong  to  the  class  of  cathartics  which  promote 
alvine  evacuations.     (See  Cathartics^ 

EXCITANTS. 

Excitants  belong  to  the  class  of  stimulants  which  excite  the 
vital  powers,  causing  an  increase  of  the  circulation.  (See 
Stimulants. ) 

FEBRIFUGES   OR    ANTIPYRETICS. 

Febrifuges  are  medicinal  agents  capable  of  diminishing  the 
heat  and  allaying  the  thirst  of  fevers,  and  are  generally  recog- 
nized as  Refrigerants.  Included  in  this  class  are  nitrate  of 
potassa,  chlorate  of  potassa,  the  mineral  acids,  spirits  of 
nitrous  ether,  antipyrin,  chinoline,  salicin,  etc.,  etc. 

GERMICIDES. 

Germicides  include  all  substances  which  destroy  any  form 
of  microbe  or  disease  germs,  such  as  bacteria,  which  are  in- 
imical to  life.  Included  in  this  class  are  bichloride  of  mer- 
cury, peroxide  of  hydrogen,  iodoform,  iodol,  iodine,  salicylic 
acid,  eucalyptus,  carbolic  acid,  chlorine,  chloride  of  zinc,  per- 
manganate of  potash,  naphthol,  etc. ;  also  heat. 

HEMOSTATICS. 

Haemostatics  are  medicinal  agents  capable  of  arresting 
hemorrhage,  and  belong  to  the  class  of  Astringents.  (See 
Astringents  and  Styptics.^ 

HYPERSTHENICS. 

Hypersthenics  belong  to  the  class  of  stimulants.  (See  Stim- 
ulants) 

HYPNOTICS. 

Hypnotics  belong  to  the  class  of  Narcotics,  and  are  capable 
of  causing  sleep.     (See  Narcotics) 

LAXATIVES, 

Laxatives  are  mild  cathartics.     (See  Cathartics.) 


REMEDIAL  AGENTS.  I49 


NERVINES. 
Nervines  belong  to  the  class  of  Neurotics,  and  are  capable  of 
relieving  and  curing  disorders  of  the  nerves.     (See  Neurotics') 

NUTRITIVES. 

Nutritives  are  medicinal  agents  capable  of  quickening  as- 
similation and  building  up  the  organic  tissues.  Included  in 
this  class  are  cod-liver  oil,  gum  arable,  glycerin,  beef  extracts, 
milk,  manna,  etc.,  etc. 

PURGATIVES. 

Purgatives  are  active  cathartics,  and  are  divided  into  sev- 
eral classes,  according  to  the  nature  of  their  action,  such  as  : 
Laxatives,  which  incite  intestinal  movements  without  much 
increase  of  the  intestinal  secretions.  Included  in  this  class 
are  manna,  sulphur,  magnesia,  castor-oil,  etc.  Saline  Purga- 
tives, which  produce  increased  secretion,  and  at  the  same 
time  hasten  the  peristaltic  action,  the  stools  being  loose  and 
watery.  Included  in  this  class  are  sulphate  of  magnesia, 
phosphate  of  soda,  tartrate  of  potassium  and  sodium,  Seidlitz 
powder,  bitartrate  of  potassium,  etc.  Mercurial  Purgatives, 
principally  calomel  and  blue  mass,  which  are  supposed  to 
produce  cholagogue  effects  and  also  an  influence  peculiar  to 
themselves.  Tonic-astringent  and  resin-bearing  purgatives, 
which  have  an  influence  over  the  liver  and  the  glandular  ap- 
pendages, and  promote  the  tonicity  of  the  muscular  layer  of 
the  intestines.  Included  in  this  class  are  senna,  rhubarb, 
aloes,  jalap,  scammony,  colocynth,  podophyllum,  etc.  Hydra- 
gogue  purgatives,  which  are  very  energetic  in  their  action,  in- 
crease the  glandular  secretions  and  cause  an  abundant  outward 
diffusion  to  such  a  degree  as  to  produce  very  watery  stools  ; 
and  also  excite  rapid  and  severe  peristaltic  movements.  In- 
cluded in  this  class  are  cambogia,  croton-oil,  elaterium,  etc 
(See  Cathartics.) 

REFRIGERANTS. 

Refrigerants  are  medicinal  agents  which  are  capable  of 
diminishing  heat  and  allaying  thirst.  They  are  also  called 
Febrifuges.      Included  in  this  class  are    nitrate    of    potassa, 


150  DENTAL   MEDICINE. 


chlorate  of  potassa,  solution  of  acetate  of  ammonia,  acetic 
acid,  citric  -acid,  hydrochloric  acid,  nitric  acid,  tartaric  acid, 
spirits  nitrous  ether,  etc.,  etc. 

RESOLVENTS. 

Resolvents  belong  to  the  classes  of  Alteratives  and  Emol- 
lients, being  medicinal  agents  capable  of  reducing  inflamma- 
tion and  dispersing  morbid  swellings.  See  Alteratives  and 
Emollients. 

RESTORATIVES. 

Restoratives  belong  to  the  class  of  Stimulants  and  Tonics- 
(See  Stimulants  and  Tonics). 

SIALAGOGUES. 

Sialagogues  are  medicinal  substances  capable  of  increasing 
the  salivary  secretion  by  a  stimulant  or  irritant  effect.  By  the 
excitant  properties  of  these  agents  the  lining  membrane  of  the 
mouth  is  irritated,  the  effect  extending  along  the  ducts  to  the 
salivary  glands,  so  that  not  only  is  the  quantity  of  fluid  exhaled 
from  the  mucous  membrane  increased,  but  salivation  results. 
In  this  way  depletion  follows  their  employment,  and  more  or 
less  revulsive  effect  ensues,  which  may  prove  beneficial  to 
distant  parts  affected  by  disease.  Sialagogues  may  also  prove 
useful  in  cases  of  paralysis  of  the  tongue,  etc.,  by  their  directly 
excitant  properties  ;  also  in  local  palsy  of  the  tongue.  They 
are  occasionally  employed  as  masticatories  in  odontalgia, 
and  in  such  affections  of  the  head  as  may  indicate  the  use  of 
substances  which  excite  irritation  in  and  increased  discharge 
from  the  lining  membrane  of  the  nasal  cavities.  Included  in 
this  class  are  pyrethrum,  horse  radish,  calamus,  ginger,  to- 
bacco, calomel,  corrosive  sublimate,  blue  mass,  iodide  of  mer- 
cury, etc. 

STYPTICS. 

Styptics,  which  belong  to  the  class  of  Astringents,  are  medi- 
cinal agents  capable  of  arresting  hemorrhage  when  employed 
externally.  They  are  divided,  according  to  their  action,  into 
chemical  and  mechanical,  the  chemical  styptics  coagulating  the 
blood  exuding  from  the  part,  and  at  the  same  time  stimulating 


THERAPEUTIC   FORMS.  151 

the  tissues  to  contraction ;  whilst  the  mechanical,  as  lint,  felt, 
spider's  web,  plaster  of  Paris,  etc.,  detain  the  blood  in  their 
meshes,  or  absorb  it  until  it  coagulates,  and  thus  arrest  the 
hemorrhage.  Among  the  Astringents  which  may  be  classed 
as  Styptics  and  local  astringents  are  tannic  acid,  persulphate 
of  iron  solution,  powdered  subsulphate  of  iron,  alum,  nitrate 
of  silver,  powdered  galls,  sulphuric  acid,  matico,  gallic  acid, 
perchloride  of  iron,  catechu,  oak-bark,  rhatany,  etc.  ;  and  as 
mechanical  styptics,  collodion,  matico,  spider's  web. 

By  contraction  of  the  blood-vessels  internally :  digitalis  and 
ergot;  also  for  checking  excessive  discharges  :  acetate  of  lead, 
carbonate  of  lead,  subacetate  of  lead,  lime  water,  the  applica- 
tion of  cold  as  ice,  and  of  heat,  as  hot  water,  etc. 

VESICANTS. 

Vesicants,  which  belong  to  the  class  of  Epispastics ,  are 
medicinal  agents  capable  of  producing  a  serous  exudation 
beneath  the  cuticle.  Included  in  this  class  are  cantharides, 
cantharidal  collodion,  glacial  acetic  acid,  strong  solution  of 
ammonia,  mustard,  etc.,  etc.     (See  Epispastics) 

FORMS  IN  WHICH  MEDICINAL   SUBSTANCES  ARE  EMPLOYED. 

Alkaloids  are  bases  capable  of  combining  with  acids  to 
form  salts,  and  which  exist  as  proximate  principles  in  certain 
vegetables,  and  possess  the  properties  of  an  alkali  in  a  greater 
or  less  degree.  Alkaloids  are,  therefore,  the  active  principles 
of  medicines. 

Baths.  Medicinal  Baths  are  composed  of  tepid  water,  with 
the  addition  of  saline,  emollient,  narcotic  or  stimulant  sub- 
stances, such  as  salt,  mustard,  etc.,  etc. 

Cataplasms  are  poultices  or  plasters  composed  of  soft, 
macerated  preparations,  to  be  applied  externally. 

CoLLYKiA  are  preparations  applied  to  the  eyes.  They  are 
sometimes  dry,  but  generally  liquid,  consisting  of  infusions, 
decoctions  or  distilled  waters,  with  the  addition  of  various 
medicinal  substances. 

Confections,  or  Electuaries,  are  preparations  made  into  a 
pulpy  mass,  with  sugar  or  honey,  mucilage  or  glycerin. 


'52  DENTAL   MEDICINE. 


Decoctions  are  solutions  made  by  boiling  certain  vegetable 
ingredients  in  a  fluid,  for  the  purpose  of  extracting  the  parts 
soluble  at  that  temperature. 

Emulsions  are  preparations  composed  of  oils,  resins,  etc., 
suspended  by  means  of  mucilage,  yolk  of  egg,  sugar,  etc. 

Enemata,  or  Clysters,  are  liquid  preparations  injected  into 
the  rectum  by  means  of  a  syringe,  as  auxiliaries  to  or  substi- 
tutes for  cathartics. 

Extracts  are  preparations  obtained  by  the  evaporation  of 
a  vegetable  solution,  in  the  form  of  juices,  infusions  or  decoc- 
tions, to  a  more  or  less  fluid  consistence. 

Fomentations  are  fluid  preparations  applied  to  the  surface 
of  the  body  by  means  of  a  sponge,  flannel  or  soft  cloth. 

Fumigations  are  the  vapors  of  medicinal  substances  em- 
ployed to  purify  infected  air  by  absorbing  or  otherwise  coun- 
teracting deleterious  gases.  They  are  also  employed  in  dis- 
eases of  the  skin,  and  may  be  sometimes  substituted  for  a 
local  bath. 

Gargles  are  washes  for  the  mouth  and  throat,  and  are  gen- 
erally astringent  and  stimulating,  sedative,  refrigerant,  etc. 
To  be  of  any  service,  gargles  or  mouth  washes  must  be  fre- 
quently applied  and  persevered  in  for  some  time.  They  are 
employed  in  cases  of  inflammation  and  ulceration  of  the  mu- 
cous membrane  of  the  mouth  and  fauces. 

Glycerites  are  solutions  of  medicinal  substances  in  gly- 
cerine. 

Infusions  are  preparations  obtained  by  pouring  a  hot  or 
cold  fluid  upon  vegetable  substances,  for  the  purpose  of  ex- 
tracting their  medicinal  properties. 

Inhalants  are  remedies  in  the  form  of  steam,  for  inhalation 
directly  to  the  lungs. 

Injections  are  medicated  fluids  thrown  into  a  natural  or 
preternatural  cavity  of  the  body  by  means  of  a  syringe. 

Liniments,  or  Embrocations,  are  unctuous  medicinal  prep- 
arations to  be  applied  externally  by  means  of  friction. 

Lotions  are  liquid  preparations  or  washes,  to  be  applied  to 
the  body  externally. 


THERAPEUTIC   FORMS.  153 

Mixtures  are  fluid  preparations  containing  several  medici- 
nal ingredients,  to  be  administered  by  the  mouth. 

Ointments,  or  Cerates,  are  preparations  of  the  consistence  of 
lard,  composed  of  wax,  lard,  or  resin,  with  solid  or  liquid  in- 
gredients, for  topical  application.  Cerates  are  somewhat  harder 
than  ointments,  especially  where  wax  is  substituted  for  the  lard. 

Oleates  are  medicinal  ointments.    (See  Medicinal  Oleates). 

Pills  are  simple  or  compound  medicinal  agents,  of  a  firm 
consistence,  spherical  or  globular  in  shape,  and  generally  not 
exceeding  five  or  six  grains  in  weight. 

Plasters  are  preparations  of  a  solid  glutinous  composition, 
which,  at  the  ordinary  temperature  of  the  body,  adheres  to 
the  part  on  which  it  is  placed. 

Poultices  are  preparations  for  applying  continuous  heat 
and  moisture  and  softening  the  tissues.  Their  effects  are  to 
cause  an  afflux  of  blood  to  the  part,  dilate  the  vessels  and 
soften  the  tissues  by  the  influence  of  both  heat  and  moisture, 
and  render  the  diffusion  of  the  fluids  easy.  In  inflammatory 
conditions,  the  stasis  of  the  vessels  implicated  is  relieved,  the 
tension  of  the  parts  lessened  and  resolution  brought  about. 
Where  the  stage  of  exudation  is  present,  these  preparations  pro- 
mote the  increase  and  migration  of  the  white  corpuscle,  and  facil- 
itate the  escape  of  purulent  matter.  Poultices  also  relieve  the 
pain  of  inflamed  parts  by  relaxing  the  tissues,  and  thereby 
removing  pressure  from  the  sensory  nerve  filaments ;  they  re- 
lieve pain  in  parts  distant  from  the  points  where  their  applica- 
tions are  made,  and  have  both  a  local  and  systemic  effect. 
Poultices  are  generally  composed  of  such  substances  as  flax- 
seed-meal,  powdered  slippery-elm  bark  and  corn  meal ;  also 
bread  and  milk  are  sometimes  employed. 

The  substance  dissolved  in  hot  water  is  spread  upon  soft 
muslin  of  such  a  size  as  to  allow  one  free  end  to  fold  over  the 
mass  and  intervene  between  it  and  the  surface  of  the  skin ;  or 
it  may  be  inclosed  in  a  small  bag  of  muslin.  Glycerine  spread 
over  the  surface  of  a  poultice  will  prevent  its  drying.  Lauda- 
num is  often  added  to  mitigate  the  pain,  if  necessary;  also 
charcoal  in  the  form  of  powder.     A  yeast  poultice  is  made  of 


154  DENTAL   MEDICINE. 

brewer's  yeast  with  enough  of  flaxseed  to  give  it  a  proper  con- 
sistence. They  should  not  be  allowed  to  remain  too  long,  as 
their  effect  will  cause  the  skin  to  become  white,  wrinkled  and 
pulpy,  and  lead  to  the  formation  of  small  boils  or  abscesses  ; 
also,  in  case  of  wounded  or  ulcerated  surfaces  their  too  long 
use  will  cause  the  granulations  to  become  pale  and  flabby  and 
prevent  healing ;  besides,  if  the  granulations  are  large,  they 
lower  the  tone  and  vigor  of  the  system,  depress  the  circulation, 
and  exhaust  the  irritability  of  the  vaso-motor  nerves,  and 
thus  prevent  healing.  Poultices  are  employed  in  boils,  car- 
buncles, irritable  ulcers,  gangrenous  sloughs.  The  charcoal 
and  yeast  poultices  are  used  in  foul  wounds.  Poultices  are 
also  applied  with  benefit  in  pneumonia,  pleuritis,  pericarditis, 
hepatitis,  peritonitis,  faucial  inflammation,  etc. 

Suppositories  are  solid  preparations,  of  a  round,  cylindrical, 
or  conical  form, to  be  introduced  into  the  anus;  and  are  com- 
posed of  sedative,  astringent,  or  purgative  medicines,  com- 
bined with  suet,  cocoa-butter,  honey,  or  soap. 

Syrups  are  liquid  conserves,  made  by  dissolving  sugar  with 
some  plant,  or  in  water,  either  with  or  without  medicinal 
impregnation. 

Tinctures  are  preparations  in  the  form  of  solutions  of  the 
active  portions  of  medicinal  substances,  in  rectified  or  proof 
spirits.  A  tincture  is  called  simple  when  it  holds  only  one 
substance  in  solution,  and  compound^  when  two  or  more  ingre- 
dients are  submitted  to  the  solvent. 


DENTAL   MATERIA   MEDICA 

AND 

THERAPEUTICS. 


ACACIA— GUM  ARABIC. 

Source. — A  thorny  tree  or  shrub,  of  Arabia  and  Africa. 

Description. — The  concrete  juice  which  exudes  spontaneously 
from  the  stem  of  the  Acacia  vera,  in  the  form  of  a  gum,  which 
hardens,  on  exposure,  in  small,  irregular  or  roundish  or  oval 
pieces,  of  various  sizes,  more  or  less  transparent,  hard,  brittle 
and  pulverizable.  It  is  generally  either  white  or  yellowish 
white,  but  sometimes  of  a  deep  orange  or  brownish  color;  the 
powder,  however,  being  pure  white.  It  is  inodorous,  with  a 
feeble,  slightly  sweetish  taste,  and  when  pure  dissolves  wholly 
away  in  the  mouth. 

In  water  it  forms  a  viscid  solution,  known  as  mucilage. 

It  is  insoluble  in  alcohol,  ether  and  the  oils.  When  kept 
dry  it  undergoes  no  change. 

Chemical  Constituents. — It  consists  of  a  peculiar  proximate 
principle  known  as  Gum  or  Arabin,  composed  chiefly  of  a 
soluble  acid  substance,  Gummic  Acid  (HgCijHigOioHjO),  com- 
bined with  3  per  cent,  of  lime,  forming  a  soluble  salt,  gum- 
mate  of  calcium. 

Medicinal  Properties  and  Action, — Demulcent  and  emollient. 
It  forms  an  excellent  adjunct  to  other  medicinal  substances  of 
the  same  class,  and  an  ingredient  in  all  the  officinal  lozenges. 

Dose. — Of  the  gum,  ,5j  ad  libitum.  Of  the  mucilage  (Siv, 
water  5vj)  .^ij  to  5vj  daily,  or  ad  libitum. 

Therapeutic  Uses. — Coughs  and  hoarseness,  gastro-intestinal 
irritation,  infantile  diarrhfjea,  epistaxis  and  superficial  hemor- 
rhages ;  applied  in  the  form  of  fine  powder. 

Dental  Uses. — As  an  emollient,  in  the  form  of  mucilage,  to 
cover  and  protect  inflamed  surfaces  of  mucous  membrane. 

155 


156  DENTAL   MEDICINE. 


As  a  mechanical  styptic,  in  a  finely-powdered  form,  in  super- 
ficial hemorrhages,  such  as  from  leech  bites,  etc. 

Combined  with  borax,  it  is  a  useful  application  for  inflamed 
mucous  membrane. 

Prof  Bonafoux  of  the  Academy  of  Medicine,  Paris,  recom- 
mends a  powder  composed  of  equal  parts  of  gum  arable,  colo- 
phony and  carbon,  as  possessing  great  haemostatic  powers,  and 
capable  of  arresting  the  bleeding  of  large  arteries. 

DENTAL    FORMULA. 

For  Inflamed  Mucous  Surfaces. 

R.         Pulveris  acaciae ^ij 

Sodii  boratis 3  ^ 

Fiat  pulvis 
SiG. — Apply  to  inflamed  part. 

ACIDUM  ACETICUM— ACETIC  ACID. 

Formula. — H  CgHgOg. 

Derivation. — Purified  Pyroligneous  Acid.  Prepared  from 
wood  by  destructive  distillation  ;  contains  28  per  cent,  of  anhy- 
drous acetic  acid.     Specific  gravity  1.047. 

Dilute  Acetic  Acid — Acidum  Aceticiim  Dihitiim,  the  only 
form  in  which  it  is  employed  internally,  is  prepared  by  mixing 
one  pint  of  acetic  acid  with  seven  pints  of  distilled  water. 
Specific  gravity  1.006. 

Medical  Properties  and  Action. — Refrigerant,  diaphoretic, 
astringent,  diuretic,  stimulant,  tonic.  It  allays  restlessness  by 
allaying  thirst,  and  acts  upon  the  skin  and  kidneys ;  also  acts 
as  an  antiscorbutic.  The  strong  acid  applied  to  the  skin  causes 
intense  redness  and  pain,  followed  by  rapid  vesication. 

Dose. — Of  acetic  acid,  gtt.  iij  to  x.  Of  dilute  acetic  acid, 
5j  to  ij. 

Therapeutic  Uses. — Fevers,  night  sweats,  diarrhoea,  scurvy, 
hemorrhage  of  the  lungs,  stomach  and  nose.  Externally, 
the  strong  acetic  acid  is  applied  in  tinea  capitis,  psoriasis, 
cancer,  corns  and  warts ;  the  dilute  form  is  applied  externally 
to  gangrene,  ulcerated  throat,  in  the  form  of  gargle,  ulcers, 
sprains  and  bruises.     Owing  to  its  volatility  and  pungency,  its 


ARSENIOUS   ACID.  I57 


vapor,  when  applied  to  the   nostrils,  acts  as   an  excitant  in 
syncope,  headache,  etc. 

Dental  Uses. — Acetic  Acid  is  externally  employed  in  indo- 
lent ulcers  of  the  mouth,  cancrum  oris  and  scurvy,  both 
locally  and  internally.  It  is  also  applied  to  fungous  growths 
of  gums  and  dental  pulps,  the  stronger  acid  being  used.  In 
the  form  of  glacial  acetic  acid — Acidinn  Aceticum  Glaciate 
(concentrated  acetic  acid),  it  is  applied  externally,  as  a  caustic 
in  fungous  growths  of  gum,  dental  pulp,  etc.  In  cancerous 
ulcerations  of  mucous  membrane,  it  relieves  pain,  and  pro- 
motes a  healthier  condition. 

DENTAL  FORMULA. 

For    Indolent     Ulcers    of   the    Mouth,  For  Inflamed  Fauces. 

Cancrum  Oris,  Scurvy.  R.     Acidi  acetici f^ij 

R .     Acidi  acetici f  .5  iij  Ammonii  chloridi ....        ^j 

Aquae ^5^-  Mellis fS'ss 

Fiat  solution  Aqute f.O'^'J 

SiG. — Apply  with  a  camel's-hair  brush.  Fiat  gargar)-sma. 

ACIDUM  ARSENIOSUM— ARSENIOUS  ACID. 
WHITE  OXIDE  OF  ARSENIC-ARSENIOSUM  OXIDUM. 

Formula. — AsgOg. 

Arsenic — arsenicum,  the  metal  from  which  arsenious  acid  is 
obtained,  is  not  employed  as  a  medicine  in  its  native  state. 
It  is  combined  with  sulphur  and  certain  metals,  and  is  hard, 
brittle,  crystalline,  of  a  steel-gray  color.  When  heated  to  a 
dull  redness,  it  volatilizes  in  the  form  of  a  colorless  vapor, 
with  an  odor  like  that  of  garlic — alliaceous.  It  is  generally 
found  in  cobalt  ore.     It  is  a  powerful  poison. 

Derivation. — Arsenious  Acid  is  obtained  by  roasting  arseni- 
cal ores,  and  purifying  by  sublimation.  It  is  in  the  form  of 
a  fine  white  powder,  which  is  often  adulterated  with  chalk, 
lime,  etc.;  hence  it  is  better  to  procure  it  in  the  solid  form  or 
lump,  which  is  of  a  milk  white  color  externally,  and  often 
perfectly  tran.sparent  internally.  It  has  no  odor,  and  is  there- 
fore liable  to  be  mistaken  for  more  innocent  substances,  and 
scarcely  any  taste,  or  merely  a  faint,  sweetish  impression. 


158  DENTAL   MEDICINE. 


Medical  Properties  and  Action. — Arsenious  Acid  in  large 
doses  is  a  vifulent  irritant  poison,  but  in  doses  of  one-sixtieth 
to  one-twelfth  of  a  grain,  properly  administered,  is  a  tonic, 
increasing  the  appetite  and  improving  the  secretions,  both  in 
quality  and  quantity.  In  large  doses,  in  the  form  of  Fowler's 
Solution — Liquor  Potassii  Arsenitis  (prepared  by  boiling  64 
grains  of  arsenious  acid  and  bicarbonate  of  potassium,  each  in 
half  a  fluid  ounce  of  distilled  water,  then  adding  12  fluid 
ounces  more  of  distilled  water,  half  a  fluid  ounce  of  compound 
spirit  of  lavender,  and  afterward  water  enough  to  make  the 
solution  measure  a  pint) — it  is  a  powerful  antiperiodic.  In 
small  doses,  administered  for  a  considerable  time,  it  modifies 
the  blood,  and  through  it  nutrition,  so  as  to  remove  various 
morbid  conditions.  When  continuously  used,  a  sensation  of 
heat  in  the  throat,  oesophagus  and  stomach  is  sometimes  ex- 
perienced, nausea,  pain  in  the  stomach  and  occasional  vomit- 
ing ;  also,  great  languor  or  depression  of  spirits,  with  redness 
of  the  eyes,  swelling  of  the  eyelids  and  oedema  of  the  face; 
hence,  at  the  first  evidence  of  such  symptoms,  the  remedy 
should  be  discontinued  until  they  have  passed  away.  When 
continually  increasing  doses  are  administered,  the  arsenic 
accumulates,  and  poisonous  symptoms  quickly  appear ;  hence, 
it  is  recommended  to  begin  a  course  of  arsenic  with  large 
doses,  and  the  quantity  given  regularly  reduced.  When  arsen- 
ious acid  is  administered,  the  bowels  should  be  well  evacuated 
by  a  purgative,  given  previously,  and  the  arsenic  taken 
directly  after  a  meal,  but  never  upon  an  empty  stomach,  on 
account  of  gastric  irritation.  Its  use  should  be  omitted  for  a 
day  or  two  every  two  or  three  weeks,  and  a  mild  aperient  em- 
ployed, in  order  to  prevent  the  accumulation  of  the  arsenic  in 
the  system.  A  few  drops  of  laudanum  added  to  the  arsenical 
preparation  will  prevent  nausea  and  vomiting.  All  arsenical 
preparations  should  be  administered  with  the  greatest  regu- 
larity, at  stated  times. 

During  the  employment  of  arsenic,  the  eyes  of  the  patient 
should  be  examined  daily,  and  if  the  eyelids  and  conjunctiva 
become  inflamed,  the  remedy  should  be  discontinued ;    also, 


ARSENIOUS   ACID.  I59 


when  the  urine,  from  being  pale  and  copious,  becomes  scanty, 
acid  and  high-colored,  the  arsenic  should  be  suspended. 

Poisonous  symptoms  have  been  caused  by  half  a  grain 
of  arsenious  acid,  and  fatal  effects  have  followed  the  adminis- 
tration of  two  grains,  although  much  larger  quantities  have 
been  taken  with  impunity  ;  very  large  quantities  often  cause 
emesis,  which  removes  the  substance  from  the  stomach,  and 
thus  prevents  fatal  effects.  When  the  idiosyncrasies  of  the 
patient  are  unknown,  it  is  better  to  use  small  doses  before 
beginning  with  large  doses.  The  quantity  of  arsenic  required 
to  produce  a  fatal  effect  varies  according  to  the  susceptibili- 
ties of  the  patient  and  the  state  of  the  stomach.  Much, 
however,  depends  on  the  idiosyncrasies  of  the  individual, 
which  differ  greatly  in  different  persons.  When  large  quan- 
tities are  taken,  the  effects  are  sometimes  manifested  on  the 
cerebro-spinal  system,  death  following,  from  narcotism,  in  a 
short  time. 

The  amount  of  arsenious  acid  which  may  be  safely  intro- 
duced into  the  stomach  should  never  be  equaled  in  an  appli- 
cation to  the  pulp  of  a  tooth.  One-twentieth  of  a  grain  may 
be  a  safe  dose  medicinally,  but  a  much  less  quantity  is  sufficint 
for  devitalizing  the  pulps  of  teeth. 

When  arsenious  acid  is  swallowed  or  applied  to  a  denuded 
surface,  it  is  rapidly  absorbed  into  the  system  ;  hence  it  is  a 
dangerous  agent,  and  in  every  case  should  be  carefully  used, 
and  its  effects  closely  watched.  It  possesses  a  very  powerful 
antiseptic  property,  arresting  the  process  of  putrefaction.  The 
stomach  and  alimentary  canal  of  persons  who  have  died  from 
its  effects  have  been  found  in  a  perfect  state  of  preservation  for 
a  long  time  after  interment. 

Poisonous  doses  produce  great  intestinal  inflammation,  with 
ulceration  in  some  cases,  and  rarely,  gangrene.  It  has  also 
been  detected  after  death,  in  the  blood,  in  the  urine,  and  also 
in  the  liver,  spleen,  kidneys,  muscles  and  stomach.  A  certain 
degree  of  tolerance  in  the  use  of  arsenic  may  be  established, 
where  poisonous  doses  can  be  taken  with  impunity.  Such  a 
state  may  be  produced  by  the  constant  legitimate  use  of  the 


160  DENTAL   MEDICINE. 

agent,  or  in  the  case  of  those  who  begin  the  habit  of  arsenic 
eating  at  a^  early  age,  and  who  find  this  practice  of  service 
in  increased  breathing  power,  strength,  and  improved  bodily- 
condition.  As  long  as  such  a  habit  is  continued,  no  ill  effects 
are  apparent,  but  as  soon  as  the  arsenic  is  discontinued, 
symptoms  resembling  those  of  poisonous  doses  make  their 
appearance. 

Arsenious  acid  acts  locally  as  an  escharotic,  but  while  a  true 
escljarotic  acts  chemically,  producing  decomposition  of  the 
part  to  which  it  is  applied,  a  state  incompatible  with  life, 
arsenic  destroys  the  vitality  of  the  organized  structure,  and 
its  decomposition  is  the  consequence.  This  distinction 
should  be  remembered  in  the  use  of  arsenious  acid  in  dental 
practice. 

Arsenic  is  eliminated  by  the  liver,  kidneys,  intestinal  canal 
and  bronchial  tubes ;  and  it  is  thought  that  some  of  the  symp- 
toms produced  by  it  have  their  origin  in  the  local  effects  of 
the  poison  on  the  channels  of  excretion. 

The  symptoms  of  gastro-intestinal  arsenical  poisoning — the 
more  common  form — are  described  by  Bartholow  as  follows  : 
Burning  sensation  at  the  epigastrium,  and  extending  over  the 
abdomen  ;  violent  and  uncontrollable  vomiting ;  excessive  dry- 
ness of  the  mouth  and  fauces,  intense  thirst,  intestinal  irrita- 
tion, bloody  and  offensive  stools,  retracted  abdomen,  strangury, 
suppression  of  urine,  or  bloody  urine,  and  in  females  menor- 
rhagia ;  rapid  and  feeble  action  of  the  heart,  oppressed  breath- 
ing, great  agitation  and  restlessness,  shrunken  features,  cold 
breath,  involuntary  evacuations,  collapse ;  consciousness  being 
retained  to  the  end. 

The  symptoms  of  the  cerebral  form  of  arsenical  poisoning 
are  profound  insensibility  and  coma,  similar  to  extreme  opium 
narcosis.  The  effects  of  arsenical  poisoning,  when  not  fatal, 
are  felt  for  a  long  time  in  the  form  of  gastro-enteric  irritability, 
an  irritable  condition  of  the  skin,  stiffness  of  the  joints,  neural- 
gic pains,  numbness,  formication,  paralysis,  etc. 

After  death  from  arsenical  poisoning,  the  gastro-intestinal 
mucous  membrane  exhibits  deep  redness,  erosions,  ecchymosis 


ARSENIOUS   ACID.  161 


and  softening.     Death  generally  occurs  in  the  midst  of  con- 
vulsions, followed  by  rigid  spasm  of  the  whole  body. 

When  arsenic  has  been  injudiciously  administered  for  too 
long  a  period,  in  addition  to  the  irritation  of  the  conjunctiva, 
swelling  of  the  face,  desquamation  of  the  skin,  etc.,  salivation 
has  been  observed  in  some  instances,  and  at  times  a  peculiar 
silvery  whiteness  of  the  tongue. 

Dose. — Of  arsenious  acid,  gr.  gV  to  gr.  ^,  in  pills  with  bread 
crumb  three  times  a  day.  Of  liquor  potassii  arsenitis  (Fow- 
ler's Solution),  TTLij  to  TTLx,  three  times  a  day ;  each  fluid 
drachm  contains  half  a  grain  of  arsenious  acid. 

Arsenic  is  contraindicated  in  infancy  and  childhood ;  in  all 
sthenic  diseases  accompanied  by  strong  arterial  action ;  in  all 
irritable  conditions  of  the  stomach  and  alimentary  canal ;  and 
in  all  inflammatory  and  pulmonary  affections. 

Therapeutic  Uses. — In  intermittent  and  periodic  diseases, 
such  as  malaria,  neuralgic  and  spasmodic  diseases,  being  of 
great  value  in  neuralgia,  especially  when  of  a  malarial  type, 
hemicrania,  chronic  rheumatism,  asthma,  whooping-cough, 
chorea,  diseases  of  the  skin,  vomiting  of  pregnancy,  hay  fever, 
irritative  dyspepsia,  uterine  affections,  bites  of  venomous 
snakes,  etc.  Externally  it  is  applied  to  cancerous  growths ; 
hypodermically,  in  cases  of  local  chorea. 

Arsenic  is  also  employed  medicinally  in  the  forms  of  arseni- 
ate  of  iron  {Ferri  Arsenias)  and  arseniate  oi  soda  {Sodce 
Arsenias). 

Dental  Uses. — The  devitalizing  power  of  arsenious  acid 
being  far  more  powerful  than  its  escharotic  power,  it  has  been 
employed  for  many  years  to  destroy  the  vitality  of  the  pulps 
of  teeth,  for  which  purpose  it  is  generally  combined  with 
either  the  acetate  or  sulphate  of  morphia  and  sufficient  creasote 
to  form  a  paste,  to  prevent,  or  at  least  mitigate,  the  extremely 
painful  action  of  the  arsenic  when  topically  applied  to  living 
tissue.  It  was  formerly  supposed  that  creasote  was  a  solvent 
for  the  arsenic,  but  this  is  now  denied.  Carbolic  acid  may  be 
substituted  for  the  creasote. 

As  the  danger  of  absorption  is  great,  there  is  considerable 
II 


162  DENTAL   MEDICINE. 


risk  in  applying  arsenious  acid  to  the  teeth  of  young  persons, 
or  those  vejy  susceptible  to  the  influence  of  this  agent ;  hence 
other  escharotics,  such  as  repeated  applications  of  carbolic 
acid,  or  pepsina  porci,  with  dilute  hydrochloric  acid,  or  nitric 
acid,  chromic  acid,  or  chloride  of  zinc,  or  the  galvanic  cautery, 
or  the  surgical  method  of  introducing  into  the  body  of  the 
pulp  a  barbed  wire,  are  employed  in  such  cases.  The  arsenious 
acid,  when  employed  for  the  devitalization  of  dental  pulps, 
has  been  combined  with  pulverized  charcoal,  under  the  im- 
pression that  the  latter  prevents  the  rapid  absorption  of  the 
arsenic,  and  thus  limits  its  action  mechanically  rather  than 
therapeutically. 

The  creasote  (or  carbolic  acid),  employed  in  combination 
with  the  arsenious  acid  as  a  nerve  paste,  obtunds  sensibility, 
acting  as  a  styptic,  antiseptic  and  escharotic ;  hence  some 
depend  upon  this  agent  alone  to  modify  the  action  of  the 
arsenic,  and  dispense  with  the  morphine. 

Tannic  acid  and  tincture  of  aconite  are  sometimes  substi- 
tuted for  the  morphine  and  creasote,  or  carbolic  acid,  in  the 
preparation  of  a  nerve  paste.  Arsenious  acid  is  also  employed 
alone,  in  the  form  of  a  dry  powder,  to  devitalize  pulps  of  teeth; 
but  it  is  not  only  more  painful,  but  less  prompt  in  its  action 
than  when  it  is  combined  with  other  agents.  Previous  to  the 
application  of  the  arsenical  preparation,  chloroform,  tincture 
of  aconite,  sulphate  of  atropine,  cocaine,  etc.,  may  be  applied 
to  the  exposed  portion  of  the  pulp,  and  the  painful  effect  of 
the  arsenic  be  thus  modified.  The  spray  of  rhigolene,  or  ab- 
solute ether,  has  also  been  employed  for  this  purpose. 

The  quantity  of  arsenious  acid  to  be  employed  for  devitali- 
zation will  depend  upon  the  structure  and  class  of  the  tooth, 
varying  from  the  y^,  gVi  td"  to  the  ^  of  a  grain ;  also  the  length 
of  time  the  arsenical  preparation  should  remain  in  the  tooth,  as 
the  condition  of  the  pulp  and  tooth,  the  age  of  the  patient,  the 
quality  of  the  tooth  structure  and  the  susceptibility  of  the 
patient,  should  all  be  considered.  While  in  most  cases  pulps 
are  readily  devitalized  by  the  application  of  a  moderate  quantity 
of  the  agent,  in  other  cases  it   appears  to  be  impossible  to 


ARSENIOUS   ACID.  I63 


accomplish  this  object  without  extra  measures  are  resorted  to. 
In  teeth  of  a  soft,  frail  structure,  owing  to  an  excess  of  organic 
matter,  the  arsenic  is  rapidly  absorbed ;  but  if,  on  the  other 
hand,  the  tooth  is  of  a  dense  structure,  the  retention  of  the 
arsenical  preparation  for  a  much  longer  time  may  not  be 
attended  with  any  injurious  effects,  such  as  peridental  inflam- 
mation. From  twelve  to  twenty-four  hours  are  generally 
required  to  enable  the  arsenious  acid  to  properly  devitalize  the 
pulp  of  a  tooth ;  the  difference  in  time  depending  upon  the 
quantity  of  the  acid  employed,  as  well  as  upon  other  circum- 
stances already  enumerated.  To  produce  a  speedy  effect,  the 
pulp  should  be  freely  exposed  by  the  careful  application  of  the 
excavator,  and  the  devitalizing  agent  applied  directly  to  the 
exposed  surface  of  the  organ.  Accuracy  as  to  the  quantity  of 
the  arsenious  acid  to  be  employed  may  be  arrived  at  by  hav- 
ing a  grain  divided  into  forty  to  sixty  parts,  by  weight,  in  the 
form  of  the  dry  powder.  A  pellet  of  cotton,  on  the  end  of  an 
excavator,  may  then  be  saturated  with  creasote  or  carbolic 
acid  or,  what  may  be  more  painless,  oil  of  cloves,  and  the  de- 
sired quantity  of  the  powder,  being  taken  up  on  the  pellet,  can 
be  placed  directly  in  contact  with  the  exposed  surface  of  the 
pulp,  and  secured  in  the  carious  cavity  by  means  of  a  second 
pellet  of  cotton,  saturated  with  either  sandarach  or  shellac  var- 
nish, a  solution  of  gutta  percha  and  chloroform,  wax  of  sof- 
tened gutta  percha.  To  properly  secure  the  arsenical  prepa- 
ration in  the  cavity  of  a  tooth,  a  concave  disk  of  thin  platinum 
may  be  placed  over  it,  and  a  temporary  filling  of  soft  gutta 
percha  introduced  into  the  carious  cavity.  Many  condemn  the 
use  of  sandarach  or  other  varnish  to  seal  the  arsenic  into 
cavities,  preferring  a  filling,  such  as  softened  gutta  percha,  etc., 
to  confine  the  arsenic  more  securely. 

Dr.  Chas.  Truman  suggests  a  mixture  of  iodoform  and  ar- 
senious acid  as  a  painless  devitalizer  under  all  conditions.  It 
is  applied  as  follows:  After  placing  the  rubber  dam  in  position, 
drying  cavity,  etc.,  the  amount  of  the  arsenious  acid  it  is  pro- 
posed to  employ  is  placed  upon  a  glass  slide  and  an  equal 
quantity  of  iodoform,  or  an  excess  is  added  and  a  paste  made 


164  DENTAL   MEDICINE. 


with  a  five  per  cent,  solution  of  carbolic  acid,  and  the  whole 
carried  to  the  pulp  on  a  piece  of  cotton,  the  size  of  a  pin's 
head.  This  is  then  covered  with  a  gutta  percha  cap,  or  one 
of  platinum,  and  a  temporary  filling  introduced ;  the  latter 
may  consist  of  softened  gutta  percha  or  zinc  filling  material. 
Pressure  upon  the  pulp  must  be  avoided. 

Some  prefer  to  wound  the  pulp,  so  as  to  draw  blood,  before 
the  application  of  the  arsenical  preparation  is  made,  and  thus 
insure  its  speedy  action.  Care  is  necessary  that  the  arsenic 
should  be  completely  secured  in  the  carious  cavity,  and  no 
portion  of  it  come  in  contact  with  the  parts  outside  of  the 
tooth.  In  the  case  of  proximal  cavities,  a  roll  of  bibulous 
paper,  saturated  with  sandarach  varnish,  may  be  pressed  be- 
tween the  teeth,  beyond  the  cavity,  and  thus  prevent  the 
arsenical  preparation  from  coming  in  contact  with  the  gum 
and  cheek,  or  gutta  percha  may  be  softened  and  packed 
against  the  margin  of  the  gum  in  such  a  quantity  as  will  fill 
the  interspace.  Failure  to  observe  such  precautions  may  re- 
sult in  violent  inflammation  involving  the  alveoli  and  causing 
necrosis  of  the  bone.  After  the  devitalization  of  the  pulp  has 
been  accomplished,  it  is  necessary  that  every  particle  of  the 
arsenic  should  be  removed  from  the  tooth.  The  effect  of  per- 
mitting the  agent  to  remain  in  the  tooth  for  a  longer  time 
than  is  necessary  for  the  devitalization  of  the  pulp  only,  is 
peridental  inflammation.  Where  several  applications  of  the 
arsenical  preparation  fail  to  produce  the  desired  devitalization, 
the  resistance  thus  offered  to  the  influence  of  the  agent  may 
be  owing  to  several  causes  :  a  granulated,  protective  covering, 
which  is  formed  over  the  surface  of  the  exposed  portion  of  the 
pulp,  which  defends  it  from  the  action  of  the  arsenic;  or, 
extraordinary  vital  power  in  the  pulp,  which  may  be  due  to 
the  peculiar  constitution  of  the  patient,  who  probably  would 
not  be  as  susceptible  to  the  action  of  arsenic  as  the  majority 
of  persons  are,  even  if  it  were  administered  by  the  mouth. 

Such  resistance  to  the  action  of  the  devitalizing  agent  may 
be  overcome  either  by  the  removal  of  the  granulated  surface 
where  it  exists,  or,  in  cases  of  non-susceptibility,  by  punctur- 


ARSENIOUS   ACID.  165 


ing  the  pulp  with  a  pointed  instrument,  charged  with  the 
arsenical  preparation ;  first  taking  the  precaution  to  obtund 
the  sensibility  of  the  organ  by  the  application  of  a  benumbing 
agent.  The  action  of  arsenic  depends  upon  both  local  and 
systemic  conditions.  When  the  capillaries  of  the  pulp  are 
congested  as  a  result  of  the  inflammation,  the  absorption  of 
the  agent  is  prevented  or  retarded,  and  it  acts  chemically  upon 
the  superficial  tissue  of  the  exposed  portion  of  the  pulp  and 
causes  pain,  rendering  it  necessary  to  relieve  the  congestion 
before  the  nerve  tissue  can  be  primarily  affected.  In  case  of 
a  lymphatic  temperament,  characterized  by  low  vital  power 
and  excess  of  fluids  in  the  tissues,  the  arsenic  is  readily  ab- 
sorbed and  devitalization  speedily  results;  whereas  in  cases 
where  there  is  great  nerve-power  or  excessive  nervous  irrita- 
bility, the  susceptibility  of  the  tissues  to  its  influence  is  very 
feeble,  and  the  devitalization  of  the  pulp  is  difficult  and 
sometimes  impossible,  unless  repeated  applications  are  made. 
It  is  not  considered  advisable  to  apply  arsenious  acid  to 
a  dental  pulp  in  an  acute  stage  of  inflammation,  and  the 
method  generally  pursued  in  such  cases  is  to  remove  the 
loose  matter  in  the  cavity,  first  applying  the  rubber  dam,  and 
relieve  the  congestion  by  slightly  puncturing  the  pulp  so  as  to 
cause  a  slight  hemorrhage.  Then  apply  an  anodyne,  such  as 
oil  of  cassia,  oil  of  cloves,  eugenol,  terpinol,  or  other  agent  of 
like  properties.  This  should  be  carefully  sealed  in  the  cavity, 
without  pressure  being  made  upon  the  pulp,  for  from  one  to 
three  days,  according  to  the  degree  of  inflammation  existing 
in  the  parts.  At  the  expiration  of  such  time,  the  dressing  is 
removed,  and  if  the  inflammation  has  subsided,  as  is  shown 
by  the  symptoms  presented  during  the  period  the  dressing 
has  remained  in  the  tooth,  an  application  of  arsenious  acid 
may  be  made.  Upon  the  removal  of  the  arsenic,  an  applica- 
tion of  tannin  and  glycerin  should  be  made  in  order  to  harden 
the  devitalized  pulp  and  render  its  removal  easy  in  the  form 
of  an  entire  mass;  then  apply  some  efficient  antiseptic  dress- 
ing to  pulp-canal,  first  washing  out  with  peroxide  of  hydrogen. 
The  use  of  dialyzed  iron  is  also    recommended,  after  the  re- 


166  DENTAL   MEDICINE. 


moval  of  the  arsenic,  as  it  is  not  always  certain  that  the  latter 
agent  has  h,een  carefully  applied.  The  dialyzed  iron  is  intro- 
duced into  the  cavity  on  a  piece  of  wood.  The  cavity  should 
be  kept  free  of  moisture  from  the  time  of  the  application  of 
the  arsenic  up  to  the  time  of  the  application  of  the  dialyzed 
iron. 

When  arsenious  acid  is  applied  to  the  surface  of  an  exposed 
pulp,  its  first  effect  is  stimulating-,  followed  by  paralysis  of  the 
sensory  nerves,  a  degree  of  inflammation  being  excited  which 
depends  upon  the  quantity  of  arsenious  acid  employed.  After 
the  stimulating  effect  passes  off  the  arsenic  is  gradually  ab- 
sorbed and  the  pulp  slowly  dies.  Too  large  a  quantity  of  the 
arsenic  will  cause  violent  inflammatory  action,  increase  the 
congestion  and  prevent  the  pulp  from  absorbing  the  agent ;  and 
experience  has  shown  that  recently  exposed  pulps  are  more 
readily  devitalized  by  arsenious  acid  than  those  which  have 
been  exposed  for  a  considerable  time.  It  is  therefore  advisable 
to  employ  minute  quantities  of  arsenic  as  a  devitalizing  agent, 
and  to  avoid  pressure  on  the  pulp  when  applying  it,  so  that 
the  pain  occasioned  by  its  action  may  be  limited  to  the  space 
of  one  hour  on  an  average.  The  danger  of  an  excess  of  arsenic 
passing  through  the  apical  foramen  of  the  root  to  the  peri- 
dental membrane  must  always  be  guarded  against  by  carefully 
regulating  the  quantity  of  the  agent;  on  the  other  hand  all  ex- 
traneous matters  that  will  interfere  with  the  action  and  appli- 
cation of  the  arsenic  to  the  exposed  surface  of  the  pulp  must 
be  removed  or  irritation  and  pain  and  not  devitalization  will 
result.  For  the  application  of  arsenious  acid  to  the  surface  of 
a  fractured  tooth,  where  it  is  difficult  to  retain  it,  the  filling 
may  be  ligatured  in  place,  after  being  covered  with  a  thin  layer 
of  gutta  percha.  Dr.  E.  C.  Kirk  uses  for  such  a  purpose  sur- 
geon's rubber  plaster,  carrying  it  around  the  tooth. 

Arsenious  acid  is  also  employed  in  dental  practice  to  obtund 
the  undue  sensitiveness  of  dentine,  but  less  frequently  now 
than  in  past  years,  as  its  action  is  due  more  to  devitalizing 
energy  than  to  a  chemical  action,  such  as  a  true  escharotic 
produces.     As  it  is  capable  of  being  absorbed  through  a  con- 


ARSENIOUS   ACID.  IQJ 


siderable  thickness  of  dentine,  the  result  of  which  would  be 
the  death  of  the  pulp,  arsenious  acid,  if  it  is  employed  for  ob- 
tunding  the  sensibility  of  the  dentine,  should  be  suffered  to 
remain  in  the  tooth  but  a  very  short  time — from  one  to  three 
hours — and  every  particle  of  it  carefully  removed.  As  there 
are  many  agents  which  prove  effective  for  such  a  purpose,  it  is 
much  better  to  refrain  from  the  use  of  arsenious  acid  as  an  ob- 
tunder  of  hyper-sensitive  dentine. 

When  arsenious  acid  comes  in  contact  with  the  soft  tissues 
of  the  mouth,  the  result  of  careless  application,  its  irritating 
effects  become  apparent  in  from  twelve  to  twenty-four  hours, 
beginning  with  a  slight  soreness  and  some  congestion.  Small 
ulcers  then  appear  which  increase  in  depth  but  are  not  attended 
with  much  pain,  unless  the  agent  penetrates  to  the  periosteum. 
The  parts  involved  eventually  become  quite  dark  in  color,  and 
sloughing  occurs  to  some  extent.  Dr.  Faught  suggests  the 
following  treatment:  "Wherever  practicable,  the  soft  tissues 
should  be  curetted.  Scarify  freely,  and  then  touch  the  wound 
with  muriated  tincture  of  iron;  then  cauterize  it  with  car- 
bolic acid  or  iodine,  and,  if  need  be,  stimulate  further  in  « 
few  days  with  another  application  of  the  same." 

DENTAL   FORMULA. 

Garrettson. 

R .     Acidi  arseniosi, 

Morphinse  acetatis  .  aa  gr.x 

Creasoti q.s. 

, ,  To  make  a  thick  paste. 

■~  ^  D      J  SiGNA. — To  remain  24  hours  for  adults ; 

Flat  massa.  ^  ■ 

c.„„.      T-i.  _»  ...  10  hours  for  children. 

bIGNA. —  I  he  property  quantity  to  remam 

.    ^  ,  If  a  very  irritable  condition  is   pres- 

12  to  24  hours.  ■'  .  "^    . 

ent,  sulphate  of  atropia  may  be  substi- 

Pierce.  *"'"^  f"""  "^"'P^'^' 

„       A  -J-  Hollander. 

jjc.     Acidi  arseniosi    .    .    .  gr.x 

Morphinae  .sulphatis    .  gr.xx  R.     Acidi  arseniosi  .    .    .  gr.xij 

Creasoti q.s.  Morphina;  acetatis      .  gr.ij 

To  make  a  thick  paste.  Olei  caryophylli     .    .  gtt.iv 

SiGNA. — To  remain  24  hours  for  adults;  Crea.soti       q.s. 

10  hours  for  children.  Ut  fiat  pasta. 


J^or  Devitalizing  Pulps 

of  Teeth. 

Flagg. 

R .     Acidi  arseniosi    .    .    . 

gr-j 

Morphinse  acetatis.     . 

gj--'j 

Acidi  carbolici    .    . 

.  gtt.iij. 

168 


DENTAL   MEDICINE. 


R .  Acidi  arseniosi  .  .  .  gr.v 
Acidi  tannici  ....  gr.x 
Tincturse  "aconiti  .  .  .  q.s. 
To  make  a  thick  paste. 

SiGNA. — ^To  remain  24  hours. 

J.  D.  White. 
R .     Acidi  arseniosi     .    .    .  gr.ij 
Morphinse  sulphatis     .  gr.j 

Creasoti q.s.         M. 

Fiat  massa. 
SiGNA. — To  remain  from  12  to  24  hours. 

R .     Acidi  arseniosi  .    .    .  gr.xx 
Morphinse  acetatis     .  gr.x 

Creasoti q.s. 

To  make  a  thick  paste. 
SiGNA. — To  remain  1 2  to  24  hours  for 
adults;  8  to  10  hours  for  children. 

R.     Acidi  arseniosi         .    .    .  gr.x 
Morphinae  acetatis  .    .    .  gr.xl 
Creasoti,vel  acidi  carbolici  q.s. 
To  make  a  thick  paste. 

SiGNA. — To  remain  12  to  24  hours. 

E.  C.  Kirk. 
R .     Acidi  arseniosi  .    .    . 

Cocaini  hydrochloratis  aa  gr.xx. 
Menthol  cryst     .    .    .  gr.v. 
Glycerini  .    .    .  enough  to  make  a 
stiff  paste.  M. 

SiGNA. — Use  the  desired  quantity,  and 
seciu-e  it  with  a  lead  cap  covered  with 
gutta  percha. 

For  Malignant   Ulcerations  of  a  Can- 
cerous Character. 
R.     Liquoris  hydrargyri  nitratis  .  f^j. 

A  powerful  caustic. 
SiGNA. — ^Applied  by  means  of  a  camel- 
hair  brush,  and  the  parts  then  covered 
with  Unt. 

R.     Acidi  arseniosi  ...  I  part. 

Cocaini  hydrochloras  4  parts. 

Lanolin 5  parts.    M. 

SiGNA. — To  remain  24  hours. 


For  Painless  Devitalization. 

R .     Acidi  arseniosi  .    .    .    .  gr.  ^'j 

Olei  caryophilli    .    .    .  enough  to 
make  a  paste.  M. 

Or  a  pledget  of  cotton  may  be  satur- 
ated with  the  oil  of  cloves  and  the 
arsenious  acid  taken  up  on  this 
and  applied  to  the  pulp. 

Devitalizing  Fibre. 

R.     Absorbent  cotton  .    .    .  (cross  cut 
fine.) 
Arsenious  acid    ....  gr.v. 

Tannic  acid gr-ij- 

Acetate  of  morphine  .  .  gr.x. 
Oily  carbolic  acid_  .  .  .  q.s.  for  a 
thin  paste. 
Reduce  the  cotton  by  cutting  and 
cross-cutting  to  a  soft  fine  fuzz,  then 
incorporate  it  with  the  above  mix- 
ture; dry  and  separate  into  small 
pieces  for  convenient  appUcation. 

Devitalizing  Pulps  of  Teeth. 

Dr.  a.  W.  Hari^n. 

First  apply  to  point  of  exposure  vinum 
opii  or  any  anodyne  (not  carbolic  acid) 
for  a  minute  or  two,  then  use  the  following: 
R .     Acidi  arseniosi     .    .    .    •   '^'y 
Hydrochlorate  of  cocaine,  5  ij. 

Lanolin ad.q.s. 

To  make  a  stiff  paste. 
SiGNA. — Apply  a  small  quantity  to  the 
exposure  on  a  little  square  of  gummed 
paper  about  -^-^  of  an  inch  in  size ;  this 
should  be  covered  with  a  pellet  of 
cotton  saturated  with  liquid  vaseline 
and  the  cavity  filled  with  soft  gutta 
percha,  or  paste  of  oxyphosphate  of 
zinc.  This  application  should  remain 
48  hours  in  the  case  of  an  adult ;  24 
hours  in  case  of  patient  under  21  and 
more  than  12  years  of  age;  and  8  to 
12  hours  in  case  of  a  patient  under 
12  years  of  age. 


ARSENIOUS   ACID.  169 


For  Destroying  and  Removing  Pulps.         Apply  -^^  gr.  to  the  pulp  and  allow  it  to 

^       .    „^   ^^  remain  48  hours.      Seal  cavity  with 

Dr.  a.  \V.  Harl.\n.  ,        ,        ,      ,       .      . 

gutta  percha,  when  the  dressing  is  re- 

R.     Acidi  arseniosi .    .    .    .  gr.xc;  moved  keep  cavity  dry,  and  wash  it 

Cocaini  hydrochlor.     .  gr.x ;  with  dialyzed  iron,  and  apply  alcoholic 

lodoformi gr.vtovij  solution  of  tannin.     Seal  cavity   for 

Either  oil  of  cloves,  or  eight  days  when  the  pulp  may  be  re- 
oil  of  cassia  ....  q.s.  moved  painlessly.     The  root  may  be 
To  form  a  stiff  paste.  filled  at  once. 

Tests  for  Arsenic. — Arsenic,  in  the  solid  state,  may  be  de- 
tected by  its  volatility;  heated  over  a  spirit-lamp,  it  passes 
off  in  the  form  of  a  white  vapor,  devoid  of  smell,  and  is  de- 
posited on  a  cool  surface  as  an  amorphous  powder,  or  in 
octahedral  crystals.  When  arsenic  is  thrown  on  burning 
charcoal,  it  is  deoxidized,  and  gives  out  the  garlic  odor  of  me- 
tallic arsenic.  When  heated  in  a  glass  tube  with  charcoal  or 
black  flux,  it  sublimes,  and  condenses  in  the  form  of  a  bril- 
liant steel  gray  ring  or  mirror. 

The  following  reagents  will  detect  it  when  it  is  in  aqueous 
solution:  Sulphuretted  hydrogen,  or  sulphide  of  ammonium, 
produces  a  lemon  or  yellow  sulphide  of  arsenic ;  the  addi- 
tion first  of  ammonia,  and  then  of  nitrate  of  silver,  produces 
a  light-yellow  arsenite  of  silver ;  the  addition  of  potassa,  and 
then  of  sulphate  of  copper,  produces  a  light-green  arsenite  of 
copper.  The  most  delicate  test,  however,  is  that  of  nascent 
hydrogen,  known  as  Marsh's  Test,  which  consists  of  subject- 
ing the  arsenic  to  the  action  of  nascent  hydrogen  (evolved  by 
the  action  of  diluted  sulphuric  acid  on  pure  zinc);  it  is  de- 
oxidized, and  unites  with  the  hydrogen  to  form  arseniuretted 
hydrogen  gas,  which  has  the  odor  of  garlic,  and  burns  with  a 
bluish-white  flame,  depositing  a  black  spot  of  metallic  arsenic 
on  the  surface  of  a  cold  plate  held  directly  in  the  jet. 

Reinsch's  Test  consists  in  boiling  the  suspected  material 
with  hydrochloric  acid  and  clean  copper  foil,  when,  if  any 
arsenic  is  present,  the  copper  foil  becomes  coated  with  gray 
metallic  arsenic. 

CoB.\LT, —  Cobaltum  {Formula,  Co) — is  a  metal  chiefly  found 
in  combination  with  arsenic,  either  in  the  form  of  the  arsenide 


170  DENTAL   MEDICINE. 


{tin-white  cobalt)^  or  as  gray  cobalt  ore,  with  sulphur  and  ar- 
senic. The  late  Dr.  Robert  Arthur  preferred  cobalt  as  a  de- 
vitalizing agent  to  arsenious  acid,  being  of  the  opinion  that 
less  irritation  followed  its  action,  and  consequently  greater 
immunity  from  periosteal  inflammation.  Others,  however,  do 
not  regard  cobalt  as  being  any  safer,  but,  on  the  other  hand, 
less  prompt  in  its  action  as  a  devitalizing  agent. 

ACIDUM    BENZOICUM— BENZOIC   ACID. 

Formula.—  HC^HgOg. 

Derivation. — Benzoic  Acid  is  obtained  from  benzoin  (a  bal- 
samic resin,  which  exudes  from  the  incised  stem  of  a  tree  of 
Sumatra,  Java,  Borneo  and  Siam),  either  by  sublimation  or  by 
the  action  of  alkalies  ;  it  is  also  made  from  hippuric  acid.  It 
is  in  the  form  of  white,  feathery  crystals,  of  a  silky  lustre,  a 
peculiar,  agreeable  odor,  and  warm,  acidulous  taste.  While  it 
is  sparingly  soluble  in  cold  water,  it  is  more  soluble  in  warm 
or  boiling  water,  and  very  soluble  in  alcohol,  solutions  of  po- 
tassa,  soda,  ammonia,  lime  and  concentrated  sulphuric  and 
nitric  acids.  The  fixed  oils  also  dissolve  it.  From  solution 
it  crystallizes  in  transparent  prisms.     It  is  also  inflammable. 

Medical  Properties  and  Action. — Benzoic  acid  is  stimulant, 
particularly  of  mucous  surfaces,  and  its  vapor  causes  great 
irritation  of  the  air  passages.  It  is  also  antiseptic  and  expec- 
torant, and  some  claim  that  it  is  a  more  powerful  antiseptic 
than  carbolic  acid.  Like  salicylic  and  boracic  acids,  it  pre- 
vents fermentation  and  putrefaction  and  destroys  minute 
organisms.  In  the  system,  it  is  converted  into  hippuric  acid, 
by  the  assumption  of  the  elements  of  glycocoll,  and  in  this 
form  is  excreted  in  the  urine ;  a  large  part  is  excreted  by  the 
kidneys,  as  benzoic  acid. 

Therapeutic  Uses. — Benzoic  acid  is  employed  in  chronic 
cystitis,  gout,  calculous  diseases,  jaundice,  incontinence  of 
urine  in  children,  etc. 

Dose. — gr.  x. 

Dental  Uses. — Benzoic  acid  may  be  employed  as  an  anti- 
septic in  suppurating  and  gangrenous  conditions  of  the  pulps 


BENZOIC   ACID.  ]71 


of  teeth  and  mucous  membrane ;  also  as  a  local  haemostatic 
in  combination  with  powdered  alum.  It  forms  one  of  the  in- 
gredients of  Dr.  Chapin  A.  Harris'  Gum  Wash. 

The  tinctures  of  benzoin  are  employed  in  the  treatment  of 
unhealthy  and  sloughing  wounds,  flabby  granulations,  foul 
ulcers,  as  they  destroy  the  fetor  and  stimulate  to  a  more 
healthy  growth.  In  the  antiseptic  employment  of  benzoic 
acid,  it  may  be  used  as  a  substitute  for  boracic  and  salicylic 
acids.  The  addition  of  borax  will  increase  its  solubility  in  water. 

Benzoate  of  Ammonium — Ammonii  Benzoas — will  dissolve 
phosphatic  calculi,  if  its  use  is  long  continued. 

Benzoated  Lard,  when  employed  in  the  preparation  of  oint- 
ments, prevents  chemical  change,  such  as  rancidity  or  acridity. 
It  is  prepared  by  digesting,  at  a  moderate  heat,  5ij  of  pow- 
dered benzoin  with  a  pound  of  lard. 

LiSTERiNE,  the  formula  of  which  is  thyme,  eucalyptus,  bap- 
tisia,  gaultheria,  and  mentha  arvensis,  in  combination,  each 
fluid  drachm  also  containing  two  grains  of  benzo-boracic  acid, 
is  largely  employed  as  an  antiseptic,  deodorizer,  and  disin- 
fectant, in  surgical  practice,  in  the  form  of  a  lotion,  a  gargle, 
a  dressing,  or  an  injection.  In  dental  practice,  listerine  is 
reliable  in  carious  teeth,  ulcerations  of  mucous  membrane,  and 
wounds  of  the  mouth,  in  the  form  of  a  lotion  or  dressing;  for 
alveolar  abscesses,  necrosis  and  caries  of  maxillary  bones,  in 
the  form  of  injections  and  lotions  ;  after  the  extraction  of  teeth, 
as  a  mouth  wash  ;  and  for  offensive  breath,  as  a  gargle.  It 
may  be  employed  in  its  full  strength,  or  in  various  degrees  of 
dilution  with  water. 

For  such  diseases  as  diphtheria,  catarrh,  dysentery,  scarla- 
tina, erysipelas,  smallpox,  different  forms  of  fevers,  etc.,  the 
dose  is  one  teaspoonful  three  or  more  times  a  day  (as  indi- 
cated). 

For  Stomatitis  of  Dentition. 

R.    Listerine ,^j 

R.    Listerine 5J  Glycerine §s.s 

Syr.  simplicis    ....  ^vij.         M.  Water.    .    ,  qs.  ad.  ^ij.  M. 

SiG. — A  teaspoonful  every  two  to  four 
hours  after  nursing  or  feeding. 


172  DENTAL   MEDICINE. 


or — 

For  Sore  Mouth  of  Nursing   Women. 

R.    Listerine 

Glycerine aa  3  vj 

Rose  Water o^J^^*     ^• 

SiG. — Use  as  a  mouth- wash. 

ACIDUM  BORICUM— BORIC  ACID— BORACIC  ACID. 

Formula.  — H  BO^ . 

Derivation. — Boric  Acid,  formerly  called  Boracic  Acid,  is 
obtained  artificially  by  decomposing  a  hot  saturated  solution 
of  borax  with  sulphuric  acid,  which  unites  with  the  soda  to 
form  sulphate  of  soda,  and  liberates  the  acid.  It  is  in  the  form 
of  white,  shining  crystals,  of  a  scaly  nature.  It  is  soluble  in 
26  parts  of  cold  water,  in  three  parts  of  warm  water,  and  feebly 
soluble  in  alcohol. 

Medical  Properties  and  Action. — Boric  acid  is  antiseptic  and 
deodorant.  It  destroys  minute  organisms,  and  arrests  fer- 
mentation and  putrefactive  decomposition,  and  is  said  to  be  as 
effective  an  antiseptic,  as  carbolic  acid,  and  less  irritating 
than  salicylic  acid. 

Therapeutic  Uses. — It  is  locally  employed  as  a  dressing  for 
wounds,  ulcers,  burns,  scalds,  skin-grafting,  etc.,  as  it  is  non- 
irritating,  and  lessens  suppuration,  and  prevents  decomposi- 
tion. Boric  acid  is  employed  in  all  the  forms  and  combina- 
tions in  which  carbolic  and  salicylic  acids  are  used  by  the  anti- 
septic method,  in  the  form  of  a  saturated  solution. 

Boric  Lint  is  made  by  steeping  lint  in  a  saturated  solution 
of  boric  acid  at  the  boiling  point. 

Dose. — Of  boric  acid,  gr.  viij  to  xvj.  It  does  not  cause  any 
disturbance  of  the  stomach,  and  is  eliminated  in  the  urine. 

Boro-glyceride  is  composed  of  boric  acid  62  parts,  and 
glycerine  92  parts,  each  gently  heated  over  a  water  bath  and 
the  boric  acid  gradually  added  to  the  glycerine,  and  the  heat 
continued  until  54  parts,  or  three  molecules  of  water  are  driven 
off  It  is  amber-colored  and  very  friable,  and  proves  to  be  a 
valuable  antiseptic. 

Boro-glyceride  has  an  acid,  pungent  taste,  and  an  astringent 


CARBOLIC  ACID.  173 


effect  on  mucous  membranes,  and  is  free  from  some  of  the 
objections  to  the  use  of  the  boric  acid  powder.  (See  Glycerine 
for  Glyceroborates  of  Sodium  and  Calcium.) 

Boric  Ointment  is  composed  of  boric  acid  i  part ;  paraffin 
2  parts  ;  almond  oil  2  parts.  When  used  it  should  be  mixed 
with  a  little  glycerine. 

Mel  Sodii  Boratis — Hone}'  of  Borax — is  composed  of  borax, 
60  grains  ;  honey,  i  troy  ounce. 

Dental  Uses. — Boric  acid  may  be  employed  as  an  antiseptic 
in  all  the  forms  and  combinations  in  which  carbolic  and 
salicylic  acids  are  used,  and  when  it  is  combined  with  sulphite 
of  soda  the  compound  forms  a  valuable  preparation  for  bleach- 
ing discolored  teeth.     (See  Sulphite  of  Soda.) 

Boric  acid,  in  ten  per  cent,  solution,  may  be  used  with 
benefit  in  the  form  of  an  injection  into  suppurating  cavities. 
As  a  mouth-wash  and  gargle  it  is  employed  in  a  solution 
composed  of  twenty  grains  to  the  ounce  of  water.  Combined 
with  glycerine  in  the  form  of  boro-glyceride,  a  valuable  appli- 
cation is  secured  for  antiseptic  dressings  and  injections.  One 
part  of  boric  acid  in  130  of  water  is  used  as  a  germicide. 

For  Aphthous  Ulcerations  of  Mouth,  Fissured 
For  Alvejlar  Pyorrhoea.  Tongue,  Abrasions  by  Artificial  Dent- 

ures, etc. 
R.     Creta  preparatse   .    .   ^j  C.  N.  Peirce. 

Acidum  boricum  .    .  ^).  M.     R.     Acidum  boricum   .  grs.  Ixiv 

SiG. — Apply  this  powder  to  gums  about  Olei  gaultherise  .    .    .  f^ss 

necks  of  teeth,  after  all    deposits  have  Glycerini f.^'^ 

been  thoroughly  removed,  and  aromatic  Alcoholis f^^j 

sulphuric  acid  injected.  Aquae  enough  to  make  four  omices.     M. 

For  Chapped  Lips  and  Abrasions. 
R.     Acidum  boricum    ....    2  parts  ; 

Vaselin 30     " 

Glycerini 3     " 

Attar  of  Roses,  for  perfume,  a  few  drops,  if  used  as  a  lip  salve. 

ACIDUM  CARBOLICUM— CARBOLIC  ACID. 

phenicacid;  phenylic  alcohol  ;  phenol. 
Formula. — CgH^HO. 
Derivation. — Carbolic  Acid  is  obtained  from  coal  tar  by  frac- 


174  DENTAL   MEDICINE. 


tional  distillation  and  subsequent  purification,  being  extracted 
from  that  part  of  the  heavy  coal-tar  oils  which  distill  over 
between  150°  and  200°  Centigrade.     Specific  gravity  1.065, 

When  pure,  it  is  in  the  form  of  colorless  acicular,  interlac- 
ing crystals,  which  at  95°  F.  become  an  oily  liquid,  possessing 
a  strong  odor  and  taste,  closely  resembling  creasote,  having 
similar  characters  and  properties,  although  it  is  a  different 
substance.  Much  of  what  is  called  creasote  is  nothing  but 
impure  carbolic  acid  {Aciduni  Carbolicinn  Impiirum),  com- 
bined with  two  other  substances,  similar  in  constitution,  and 
known  as  creasole  and  phosole. 

Chemically  considered,  carbolic  acid  is  an  alcohol  rather 
than  an  acid,  and  its  crystals  readily  absorb  moisture  on  ex- 
posure to  the  air,  and  are  thus  liquefied. 

It  crystallizes  at  70°  F.,  and  becomes  liquid  at  from  90°  to 
95°  F.,  and  fuses  at  93°  to  106°.  It  is  freely  soluble  in  alcohol, 
ether,  chloroform,  glycerine  and  the  essential  oils.  When 
carbolic  acid  is  liquefied  and  discolored  by  exposure,  it  is  diffi- 
cult to  detect  it  from  creasote,  as  it  possesses  the  same  odor, 
taste,  caustic  properties,  and  a  like  affinity  for  albumen.  Car- 
bolic acid  is  soluble  in  from  twenty  to  twenty-three  parts  of 
water,  the  purest  being  the  most  soluble.  A  small  quantity 
of  water  will  convert  it  into  the  liquid  state,  but  will  not  dis- 
solve it.  Water  dissolves  six  per  cent,  of  carbolic  acid,  and 
five  parts  dissolve  in  one  part  of  alcohol ;  four  in  one  part  of 
ether ;  three  in  one  part  of  chloroform  ;  seven  in  two  parts  of 
glycerine,  and  four  in  seven  parts  of  olive  oil.  It  is  also  solu- 
ble in  carbon  disulphide,  benzol  and  fixed  and  volatile  oils. 
The  best  quality  of  carbolic  acid  contains  two  per  cent,  of 
water,  and  should  be  hard  and  dry,  with  no  odor  of  creasote 
nor  of  volatile  sulphur  compounds.  Crystallized  carbolic  acid 
may  be  dissolved  by  a  small  quantity  of  cologne  water  ;  and 
to  prevent  recrystallization  and  prepare  it  for  use  (in  the  form 
of  injections,  for  example),  the  bottle  containing  it  should  be 
warmed  by  immersion  in  hot  water,  until  it  becomes  fluid,  and 
about  five  per  cent,  of  rectified  alcohol,  or  a  few  drops  of 
glycerine,  be  added. 


CARBOLIC  ACID.  175 


The  red  color  which  it  assumes  on  exposure  is  thought  to 
be  caused  by  the  ammonia  in  the  air,  and  also  by  the  presence 
of  copper  in  the  acid,  which  is  affected  by  the  ammonia  of  the 
atmosphere. 

Medicinal  Properties  and  Action. — Carbolic  acid  resembles 
creasote  so  closely  in  many  of  its  characters  and  medicinal 
properties,  that  the  therapeutic  applications  are  the  same  in 
the  case  of  both  of  these  substances.  Many,  however,  con- 
sider carbolic  acid  to  be  more  efficacious  in  obstinate  dis- 
charges than  creasote  ;  and  also  less  irritating  in  its  crystalline 
form  when  applied  to  very  sensitive  organs,  such  as  the  pulp 
of  a  tooth. 

In  its  pure  state  it  is  escharotic;  when  diluted,  it  is  rube- 
facient, anaesthetic  and  antiseptic.  Internally  administered,  it 
is  sedative  and  carminative,  possessing  the  power  of  allaying 
vomiting  and  gastric  irritability. 

Its  powers  as  an  antiseptic  and  germicide  are  not  now  con- 
sidered to  be  equal  to  those  of  some  other  substances,  such  as 
bichloride  of  mercury,  iodine,  iodoform,  etc.,  although  it  is  yet 
regarded  as  a  useful  and  important  agent.  It  is  irritant  to  the 
skin  and  other  tissues,  and  capable  of  being  absorbed  to  a  dan- 
gerous amount.  Eisentein  regards  carbolic  acid  as  an  anti- 
pyretic as  inferior  to  salicylic  acid,  and  others  regard  boric 
acid  as  possessing  equal  antiseptic  properties.  As  a  local 
anaesthetic,  carbolic  acid  exerts  a  very  soothing  influence  upon 
painful  tissues  ;  hence  it  is  beneficial  in  odontalgia,  and  for 
pulp  dressing.  On  account  of  its  solubility,  a  variety  of  solu- 
tions of  special  value  can  be  formed  with  it,  which  are  especially 
serviceable  as  antiseptic  applications. 

The  application  of  large  quantites  of  carbolic  acid  to  an 
extensive  surface  is,  however,  dangerous,  as  cases  of  fatal  poi- 
soning have  resulted  by  the  absorption  of  this  acid  ;  hence, 
care  is  necessary  in  its  use  as  an  external  application. 

Its  nauseous  odor  and  taste  and  its  caustic  action  render  it 
objectionable,  unless  greatly  diluted,  for  internal  administration. 
To  obviate  such  objections,  it  is  recommended  to  use  it  in  the 
form  of  sulpho-carbolates. 


176  DENTAL   MEDICINE. 


When  applied  to  the  skin  or  to  mucous  membrane,  it  pro- 
duces a  burning  sensation,  of  short  duration,  and  the  eschar  is 
at  first  whitish,  afterward  becoming  brown  or  black,  and 
surrounded  by  a  zone  of  inflammatory  redness ;  and,  notwith- 
standing its  power  to  coagulate  albumen,  is  rapidly  diffused 
into  the  blood.  Carbolic  acid  exists  in  the  blood  as  a  carbo- 
late ;  and  the  blood  itself  does  not  appear  to  undergo  any 
change  in  its  corpuscular  elements.  It  is  in  part  consumed  in 
the  body,  and  the  products  of  its  combustion  are  excreted  in 
the  urine.  Solutions  of  carbolic  acid  of  adequate  strength 
will  check  suppuration,  and  correct  the  fetor  of  ulcers,  etc. 

Therapeutic  Uses. — Internally,  it  is  employed  for  nausea  and 
vomiting  due  to  an  irritable  state  of  the  stomach,  in  scarlatina, 
measles  and  smallpox,  pyrosis,  etc. ;  as  a  gargle  in  diphtheria ; 
as  an  inhalation  in  chronic  nasal  catarrh,  hay  asthma,  whoop- 
ing-cough, phthsis,  etc. ;  as  an  injection  in  chronic  cystitis, 
primary  syphilis,  erysipelas,  pleuro-pneumonia  and  uterine 
diseases ;  as  a  lotion  in  gangrenous  and  other  ill-conditioned 
ulcers,  carbuncle,  poisoned  wounds,  burns,  skin  diseases,  scrofu- 
lous ophthalmia  and  itching  of  the  skin. 

Dose. — Of  crystallized  carbolic  acid,  gr.  ^  to  gr.  j,  largely 
diluted.  A  better  form,  however,  is  07ie  drop  of  the  crystallized 
acid,  liquefied  by  heat,  in  one  ounce  of  mucilage,  three  times 
a  day.  The  dose  of  glycerite  of  carbolic  acid  {Glyceritmn 
Acidi  Cm'bolici),  made  by  rubbing  together  5ij  of  carbolic  acid 
with  Oss  of  glycerine,  is  Uliv. 

The  dose  of  carbolic  acid  vi-aX^r  {Aqua  Acidi  Carbolici),  f5x ; 
of  the  glycerite,  dissolved  in  distilled  water,  enough  to  make 
the  mixture  measure  a  pint,  the  dose  is  f5ss  to  f3j. 

Impure  carbolic  acid  is  employed  for  disinfectant  purposes. 

Ointment  of  carbolic  acid  [Unguentum  Acidi  Carbolici) — 
carbolic  acid,  3j  ;  lard,  Sj- 

Sulpho-carbolic  acid  (HCgHgSOJ  is  considered  to  be  a  very 
efficient  antiseptic  and  disinfectant.  The  addition  of  acids, 
particularly  sulphuric,  to  crude  carbolic  acid  of  different 
strengths  increases  its  antiseptic  and  disinfectant  properties, 
and  considerably   increases    its   solubility.     Twenty-five   per 


CARBOLIC  ACID.  177 


cent,  of  crude  carbolic  acid,  mixed  with  an  equal  quantity  of 
concentrated  crude  sulphuric  acid,  gives  the  best  results,  and 
renders  it  a  cheap  and  effective  disinfectant  and  sterilizer. 

Sulpho-carbolate  of  zinc  (Zn(C6H5S04)2H20)  combines  the 
virtues  of  zinc  salts  and  carbolic  acid,  and  is  used  internally, 
in  diarrhoea,  and  externally,  in  aqueous  solution  of  from  three 
to  six  grains  to  the  ounce,  as  a  dressing  for  wounds  and  ulcers 
and  an  injection  in  gonorrhoea. 

Sulpho-carbolates  of  sodium,  potassium,  magnesium,  calcium, 
and  quinia  are  employed  as  antiseptics  in  cholera  and  zymotic 
diseases  generally. 

Dental  Uses. — Carbolic  acid  being  antiseptic,  styptic,  eschar- 
otic,  stimulant  and  sedative,  or  narcotic,  is  a  valuable  agent 
in  dental  therapeutics.  It  has  been  employed  as  an  applica- 
tion to  carious  dentine,  to  obtund  sensibility  and  arrest  putre- 
factive changes  in  the  devitalized  structure,  and  to  coagulate 
the  albuminous  elements    at  the  end  of  the  dentinal  tubuli. 

But  it  is  now  generally  conceded  that  there  are  other  agents 
which  are  more  permanent  in  their  action  as  antiseptics,  and 
hence  carbolic  acid,  it  is  claimed,  should  not  be  introduced 
into  root-canals  permanently,  as  silico-fluoride  of  sodium,  boro- 
glycerine,  oil  of  cloves,  cassia,  cinnamon,  myrtol,  etc.,  are  far 
more  powerful,  with  better  stimulating,  antiseptic  and  disinfec- 
tant properties,  and  do  not  possess  the  coagulating  property 
of  carbolic  acid,  nor  clog  a  delicate  canal  or  destroy  the  tissues 
to  which  they  are  applied.  It  relieves  odontalgia  when 
applied  to  the  surface  of  an  exposed  and  painful  pulp.  It  is 
also  invaluable  in  the  treatment  of  alveolar  abscess;  and  in 
combination  with  iodine  or  other  agents  it  is  often  employed 
with  beneficial  effects  in  the  treatment  of  periodontitis.  When 
employed  in  the  treatment  of  alveolar  abscess,  as  an  anti- 
septic, although  the  discharge  of  pus  may  be  increased  for 
a  short  time  after  its  application,  there  is  soon  manifested  a 
decided  diminution  in  the  quantity  secreted.  When  applied 
to  a  suppurating  pulp  it  arrests  putrefaction,  and  induces  a 
healthy  action  without  irritation.  It  is  also  a  valuable  antisep- 
tic application  in  ulcerations  oi  the  mucous  membrane  of 
12 


178  DENTAL   MEDICINE. 


the  mouth,  gangrenous  conditions  and  mercurial  stomatitis  ; 
for  such  purposes  being  combined  with  glycerine  and  other 
agents.  Applied  to  exposed  pulps,  it  forms,  by  escharotic 
action,  an  eschar,  which  some  regard  as  conducive  to  the 
recovery  of  the  organ,  while  others  regard  the  quiescent  state 
it  produces  as  an  indication  of  the  degeneration  of  the  pulp, 
and  hence  prefer  to  use  it  in  a  diluted  form,  for  the  same  object, 
objecting  to  its  employment  in  its  pure  state,  on  account  of 
its  escharotic  or  caustic  effect. 

It  is  also  useful  as  a  styptic  in  case  of  superficial  hemor- 
rhage from  the  gums  after  the  extraction  of  teeth,  especially 
in  combination  with  other  agents.  A  preparation  known  as 
phenol  sodique  is  often  employed  for  such  a  purpose. 

Oil  of  cloves,  when  added  to  an  equal  quantity  of  carbolic 
acid,  will  disguise,  to  some  extent,  its  taste  and  odor.  It  can 
also  be  perfumed  by  adding  to  i  part  of  carbolic  acid  3  parts 
of  oil  of  lemon  and  100  parts  of  alcohol  (36  degrees).  Car- 
bolic acid  is  also  employed  to  check  the  hemorrhage  resulting 
from  the  application  of  leeches  to  the  mucous  membrane  of 
the  mouth.  When  applied  to  an  ulcerated  surface,  it  should 
be  repeated,  as  pus  is  formed  or  fungous  growths  appear  ;  and 
having  formed  an  eschar  when  applied  to  an  exposed  pulp,  it 
should  not  be  repeated  until  the  eschar  is  detached  from  the 
surface.  It  has  also  been  employed  in  the  form  of  hypodermic 
injections,  for  the  relief  of  neuralgia. 

Carbolic  acid  is  also  useful  as  a  local  anaesthetic.  Com- 
bined with  glycerine  (i  part  to  12  of  glycerine),  it  will  stimu- 
late the  mucous  secretion,  and  hence  has  been  applied  to  the 
palate,  in  cases  of  deficiency  of  this  secretion  to  promote  the 
suction  of  upper  dentures. 

When  properly  diluted  with  alcohol,  it  renders  soft  and 
spongy  gums  firmer  and  less  tender. 

It  will  also  correct  fetor  of  the  breath  arising  from  carious 
teeth,  smoking,  etc.,  acting  as  a  deodorizer. 

In  all  fetid  discharges  from  the  mouth,  throat,  etc.,  carbolic 
acid,  combined  with  glycerine  or  an  aqueous  solution,  may  be 
used  with  advantage.  The  pure  acid  is  employed  for  bathing  cav- 


CARBOLIC   ACID.  179 


ities  in  teeth,  preparatory  to  the  introduction  of  the  filling  mater- 
ial, for  its  effect  on  sensitive  or  softened  dentine  and  low  organ- 
isms, although  other  agents  prove  more  effective  as  germicides. 

For  use  as  a  disinfectant,  the  form  of  carbolic  acid  which 
contains  about  ninety-four  per  cent,  of  the  pure  acid  and 
known  as  "  carbolic  acid  No.  4,"  is  the  best,  and  it  may  be 
used  as  an  antiseptic  in  the  following  strength ;  for  lotions  or 
sponges,  25/3  per  cent,  in  water;  for  spray  or  vapor,  5  per 
cent,  in  water ;  for  a  dressing,  5  per  cent,  in  olive  oil.  Car- 
bolate  of  potash  (unofficial — Robinson's  remedy)  is  composed 
of  equal  parts  of  carbolic  acid  and  caustic  potassa  rubbed  to- 
gether ;  it  is  employed  in  pyorrhoea  alveolaris  and  hyper-sensi- 
tive dentine.  Carbolic  acid  one-third  and  potassfusa  two- 
thirds  is  escharotic,  anaesthetic,  obtundant  and  disinfectant ; 
such  a  combination  causes  a  definite  slough,  and  is  useful  in 
suppurating  surfaces,  sloughing  ulcers  and  dead  tissue. 

Synthetic  Carbolic  Acid. — Hitherto  all  carbolic  acid  used  in 
medicine  has  been  prepared  from  coal  tar.  But  such  an  acid 
is  never  quite  pure,  always  containing  impurities  derived  from 
the  coal-tar.  Synthetic  carbolic  acid  is  produced  during  the 
process  of  sulphonizing  benzol  and  subsequent  fusion  of  the 
benzol-sulphonate  with  caustic  alkali.  The  most  characteristic 
difference  between  it  and  the  acid  prepared  from  coal-tar  is  the 
odor,  the  synthetic  acid  having  a  faint  "  pure  "  odor  not  like 
that  of  coal-tar,  and  almost  unperceivable  in  a  5  per  cent, 
aqueous  solution,  differing  in  this  respect  also  from  the  com- 
mercial article.  Synthetic  carbolic  acid  is  in  two  forms — in  a 
coherent  crystalline  mass,  and  in  loose  crystals.  Experiments 
made  by  Dr.  Ohlmueller,  of  the  German  Health  Dept, 
showed  that  the  synthetic  acid  diminished  the  life  activity  of 
the  bacteria  experimented  on  rather  less  than  the  older  acid, 
but  that  the  difference  was  so  small  that  the  two  kinds  might 
be  considered  to  be  practically  of  the  same  value.  One  of  the 
advantages  claimed  for  synthetic  carbolic  acid  is  its  greater 
solubility  in  water,  thus  enabling  the  operator  to  use  it  in 
greater  strength  without  diminishing  its  causticity. 

Phenol  Sodique  (unofficial)  is  a  solution  of  sodium  carbo- 


180  DENTAL   MEDICINE. 

late  and  is  extensively  employed  in  dental  practice  (See  Phe- 

nate  of  Sodk).     It  is  composed  of  pure  melted  carbolic  acid,  5 
parts;  solution  of  caustic  soda  (of  a  specific  gravity  of  1.332), 

I  part ;  distilled  water,  5  parts.  Mix. 

DENTAL    FORMULAE. 

A  Lotion  for  Soft  and  Spongy  Gums.  Alcohol  absolut    .    .     tl^xxv 

R .     Acidi  carbolici     .    .    gr.xx  Aq.  destillatffi  .    .    .     HXx 

Spiriti  rectificati  (al-  01.  menthse  pip   .    .    Ttlv. 

cohol) 5  ij  Misce  et  filtra. 

Aquse  destillatee  .    .     §vj.        M.  SiGNA. — K%  an  injection  in  pockets  of 

It  renders  the  gums  less  tender  and  gi^JH- 

*^'^^^"  A  Disinfectant  Mouth  Wash. 

An  Antiseptic  Lotion  or  Injection.  j^^   t_  g_  Patrick. 

R .  Acidi  carbolici  .    .    .     gss  ^      Acidi  carbolici  (cryst), 

Glycerini gxv.       M.  Glycerini, 

For  alveolar  abscess  and  ulcers  of  Aquae  rosse  aa  ....  zii.  M. 
mouth.  The  glycerine  modifies,  the  SiGNA.— Five  to  eight  drops  in  a  wine- 
caustic  acticai  of  the  acixi.  ^zs^  of  water. 

A  Stimulant  and  Antiseptic  Lotion.  ^     Stimulant    and    Antiseptic    Mouth 

Dr.  J.  Stocken.  Wash. 

R.     Acidi  carbolici     .    .     3J  R,     Acidi  carbolici     .    .    gtt.xx 

Glycermi g  iv  Glycerini 3;  iv 

Aquae gx.          M.  Aquae gx.         M. 

Useful  in  ulceration,  of  the  gums  and  Signa. — To  be  used  as  a  gargle, 
mucous  membrane. 

For  Fetid  Perspiration. 
For  Sensitive  Dentiite  and  Alveolar 

Pyorrhoea.  ^'      ^"^^^  carbolici  ...  2  parts 

Dr.  J.  A.  ROBINSON.  ^1^^^^^°^ 3  parts    M. 

R .     Acidi  carbolici     .    .     (cryst.).  For  Parasitic  Skin  Diseases. 

Potasse  caustic..aa_.partes  equal.  ^       Acidi  carbolici  ...  ^j. 

Misce,  by  triturating  m  a  mortar  until  Glycerini 5j.          M. 

a,,  crystalline  paste  is  formed. 

SiGNA. — Apply  on  a  loosely  rolled  twist  Antiseptic  Solution  for   Washing  and 

of  cotton    about   neck   of  tooth,    for  Spraying   Wounds,  etc. 

alveolar  pyorrhoea.     It  is  known  as  ^       Acidi  carbolici  (cryst.)  partem  j. 

i:^^^^  Robinson  Remedyr  ^^^^ part.  xxiv. 

For    Alveolar  Pyorrhma   {Riggs^    I>is-  SiGNA. — Dilute  the  above  solution  with 

ease).  equal  parts  of  water,  which  will  make 

R .     Acidi  carix)lici     .    .     tlXxxv  it  equal  to  i  part  of  the  acid  to  40 

Potassii  iodidi  .    .    .    gr.v  parts  of  water ;  for  use  in  disinfecting 

Zinci  chloridi  .    .    .    gr.xxv  instruments  and  sponges. 


CARBOLIC   ACID. 


181 


For  Dry  Month. 
H.  J.  Fish. 
R .      Acidi  carbolic!  .    .    .  gtt.x 

Glycerini ^j.  M. 

SiGNA. — Apply  on  palate  or  mouth  with 
a  soft  brush  three  times  a  day. 

For  Inhalation    in    Syphilitic  Ulcera- 
tions. 
B  .      Acidi  carbolici  ...  5  xxj 

Aqua  destillatiE     .    .   3  iij.        M. 
SiGNA. — Inhale  the  vapor.     Antiseptic. 

A  Stimulant  and  Antiseptic  Injection. 
R.      Acidi  carbolici  ...  I  part 

Glycerini 30  parts.  M. 

Useful  as  an  injection  in  chronic  forms 
of  alveolar  abscess. 

For  Odontalgia. 
B .      Acidi  carbolici, 
Chloroform, 
Liquid  opii 
Vel  morphine  hydro- 

chloratis  .    .  aa  .    .   3  ij 
Tincturse  benzoini .   .  ^j.  M. 

Apply  to  exposed  surface  of  pulp,  on 

cotton. 

A  Stimulant  and  Antiseptic  Lotion  or 

Injection. 

Percy  Boulton. 

R .      Acidi  carbolici  .    .    .  TTt^j 

Tincture  iodi     .    .    .  tTLxlv 

Glycerini ^j 

Aquse  destillatae  .  ,  ^  v.  M. 
For  inflamed  mucous  membrane,  and 
an  injection  for  chronic  alveolar  ab- 
scess ;  also  useful  in  acute  abscess  after 
the  use  of  more  powerful  escharotic  and 
antiseptic  agents. 

For  Itching  of  the  Skin. 

R .      Acidi  carbolici  .    ,    .  3  ij 

Glycerini ^j 

Aquae  rosae    ....  J  viij.      M. 

Slo.NA. — To  be  applied  by  means  of  a 
sponge. 


The  following  preparation  is  recom- 
mended for  the  relief  of  odontalgia,  by 
Dr.  K.  W.  Millican  :— 

"  Melt  white  wax  or  spermaceti,  two 
parts,  and  when  melted  add  carbolic 
acid  crystals,  one  part,  and  chloral  hy- 
drate crystals,  two  parts ;  stir  well  till 
dissolved.  While  still  liquid,  immerse 
thin  layers  of  carbolized  absorbent 
cotton-wool,  and  allow  them  to  dry. 
When  required  for  use,  a  small  piece 
may  be  cut  off  and  slightly  warmed, 
when  it  can  be  inserted  into  the  carious 
cavity  of  the  tooth,  where  it  will 
solidify." 

For  Alveolar  Pyorrhoea  {^Riggs' 
Disease.) 
R.      Acidi  carbolici  .    .    .  ttl^v 
Spts.  vini  rectif.    .    .  3  vj 
Aq.  menthse  pip    .    .   -^ij 

01.  anisi fllj 

01.  cinnamon    .    .    .  Tllss.       M. 
SiGNA. — Apply   to  gum  with    camel's- 
hair  brush. 

An  Antiseptic  and  Disinfectant 

Dentifrice. 

J.  Stocken. 

R.    Acidi  carbolici   .    .  .  IflX'^'^x 

Pulvis  ossis  sepise  .  .  jij 

Pulvis  radicis  iridis  .  ^ij 

Creta  preparatse  ,    .  .   ^  iij 

Olei  caryophylli  .    .  .  gtt.  iij.     M. 


R. 


For  a  Carbolized  Styptic. 
Acidi  carbolici   .    .    .  x  parts 


Collodii c  parts 

Acidi  tannici    .    .    .    .  v  parts 
Acidi  benzoic!     .    .    .  v  parts.    M. 
It    coagulates   blood    and    albumen, 
and  cicatrizes  the  tissues. 

For  Chilblains. 

R.    Acidi  carbolici    .    •    •  ?,) 
Tincture  iodi 3  ij 


182  DENTAL   MEDICINE. 


Acidi  tannici  .... 

.^ij 

Cereat  simplicis  .    .    . 

giv. 

M. 

Fiat  unguentum. 

For  Odontalgia. 

R .    Collodii  (flexile) .   .    . 

.^j 

Acidi  carbolici   .    .    . 

3y- 

M. 

SiGNA. — Apply  to   surface 

of  exposed 

and  painful  pulp. 

Dressing  for  Root-Canals  and 

Abscesses. 

Dr.  G.  V.  Black. 

R .    Acidi  carbolici   .    .    .  i  part 

Oleum  cassise  ....  2  parts 

Oleum  gaultheriae  .    .  3  parts     M, 

Dressing  for  Children's  Teeth. 
Dr.  L.  L.  Davis. 

R.    Acidi  carbolici  (cryst.)^j 

For  Odontalgia.  r\^  •„  ^• 

*  Oleum  cassiae  .    .    .    .  3J 

R.    Acidi  carbolici    .    .    .  ^ij  Glycerini ^j 

Morphinse  acetatis  .    .  gr.  xx.  Alcoholis     .....  ^^^ij.         M. 

Solve. — ^Applied  to  surface  of  exposed  It  quickly  relieves  pain,  and  does  not 

pulp,  on  cotton.  nauseate. 

ACIDUM  CHROMICUM— CHROMIC  ACID. 

Formula. — CrOg. 

Derivation. — Chromic  Acid  is  obtained  in  the  form  of  bril- 
Hant,  deep  red,  acicular  crystals,  by  the  reaction  of  strong  sul- 
phuric acid  upon  a  solution  of  bichromate  of  potash.  It  is 
deliquescent,  and  very  soluble  in  water  and  alcohol,  forming 
an  orange-yellow  solution. 

Medical  Properties  and  Action. — It  is  a  powerful  caustic,  de- 
composing the  tissues  by  rapid  oxidation ;  and  although  it  is 
very  slow  and  gradual  in  its  action,  yet  it  is  deeply  penetrat- 
ing and  when  action  ceases,  sesquioxide  of  chromium 
remains.  So  destructive  is  its  effect,  that  small  animals  are 
dissolved  entirely,  bones  and  all,  by  it,  in  fifteen  or  twenty 
minutes.  On  account  of  its  penetrating  deeply,  without  much 
pain,  care  is  necessary  in  its  use ;  and  when  used  as  a  caustic, 
the  surrounding  tissues  should  be  well  protected.  The  part 
on  which  it  acts  first  becomes  yellow,  then  brown,  and 
ultimately  black,  and  the  eschar  is  detached  in  from  twenty- 
four  to  forty-eight  hours.  It  is  a  powerful  oxidizer,  and  gives 
up  its  oxygen  readily  to  organic  matter,  which  it  thus  dis- 
solves. When  in  solution,  more  or  less  diluted,  its  action 
can  be  modified,  according  to  the  effect  desired. 

Therapeutic  Uses. — Chromic  acid  is  not  given  internally.  In 
the  form  of  paste,  or  solution  with  water,  it  is   a  valuable 


ACIDUM   CRESYLICUM.  183 

caustic  in  cancerous  and  other  ulcerations,  malignant  growths, 
hemorrhoids,  warts,  etc.  Chromic  acid  has  been  employed 
with  good  effect  in  syphilitic  sores,  cases  of  secondary 
syphilis,  deep  and  jagged  ulcers  of  the  tongue,  and  ulceration 
of  inside  of  the  cheek,  mucous  tubercles  and  condylomata. 
It  has  also  been  employed  in  the  treatment  of  granular 
ophthalmia,  uterine  hemorrhage,  uterine  catarrh,  etc.  It 
causes  less  pain  than  nitric  acid  and  other  caustics,  and 
should  never  be  applied  to  a  surface  to  be  cauterized  in  a 
layer  deeper  than  a  line  in  thickness.  For  removal  of  warts, 
etc.,  it  is  employed  in  a  solution  of  lOO  grains  to  the  ounce 
of  distilled  water. 

Dental  Uses. — In  dental  practice  chromic  acid  has  been 
employed  for  obtunding  sensitive  dentine;  but  its  most  val- 
uable application  is  for  the  removal  of  tumors  and  morbid 
growths  upon  the  gums,  fungous  growths  of  tooth  pulp,  etc. 
When  applied  to  any  part  of  the  mouth,  the  surrounding 
parts  should  be  carefully  protected  by  folds  of  lint  or  strips 
of  adhesive  plaster.  A  glass  rod,  or  a  gold  or  platinum  wire 
should  be  used  for  its  application.  It  is  also  useful  in  ulcera- 
tion and  recession  of  the  gums,  beginning  the  treatment  with 
a  weak  solution,  and  gradually  increasing  the  strength.  It  is 
sometimes  combined  with  glycerine,  in  which  case  the  latter 
must  be  added  to  the  acid  drop  by  drop,  in  order  to  avoid 
explosion. 

DENTAL  FORMULA. 

For  Secondary  Syphilitic  Ulcers,  and  Ulceration  of  Mucous  Afem- 

brane  of  Aiouth  and  Tongue. 

R.     Acidi  chromici gr-  x 

Aqure SJ. 

Misce  solut. 
SiG. — Paint  the  diseased  parts  three  or  four  times  a  day,   with  a 

camel's-hair  brush  dipped  in  the  solution. 

CRESYLIC  ACID— ACIDUM  CRESYLICUM. 

Cresylic  Acid  is  an  antiseptic  and  germicide  upon  the  different 
kinds  of  pathogenic  organisms.  It  is  a  colorless  liquid  having 
the  odor  of  creasote.  It  boils  at  203°  and  is  slightly  caustic. 
It  is  soluble  in  water,  quite  soluble  in  alcohol,  glycerine,  and 


184  DENTAL   MEDICINE. 


water  of  ammonia  and  very  soluble  in  ether.  When  injected 
into  rabbit?  it  produced  toxic  symptoms,  but  to  cause  death  a 
dose  four  times  greater  than  that  of  carbolic  acid  was  required. 
It  has  a  marked  effect  in  retarding  the  fermentation  of  urine 
and  milk.  Experiments  on  cultures  of  the  various  pathogenic 
micro-organisms  demonstrated  that  cresylic  acid  is  a  power- 
ful antiseptic  and  germicide,  and  quicker  in  its  action  than  car- 
bolic acid  or  its  congeners. 

ACIDUM  GALLICUM— GALLIC  ACID. 

Formula. — C^  HgOj. 

Derivation. — Gallic  Acid  is  obtained  from  galls  by  exposing 
the  powder,  in  water,  to  the  action  of  the  air,  at  a  tempera- 
ture of  between  60°  and  70°  F.,  when  the  acid  is  deposited  in 
the  form  of  small,  silky,  almost  colorless  crystals,  possessing 
a  slightly  acid  and  astringent  taste.  Gallic  acid  is  slightly 
soluble  in  cold  water,  and  freely  soluble  in  hot  water,  gly- 
cerine or  alcohol. 

Galls,  from  which  gallic  acid  is  prepared,  are  the  excres- 
cences caused  by  the  punctures  and  deposited  ova  of  a  hy- 
menopterous  insect  on  the  twigs  of  the  gall  oak  {Quercus 
Infectorid). 

Source. — Galls  are  obtained  from  Asia  Minor  and  Persia. 

Medical  Properties  and  Action  of  Galls. — Powerfully  astrin- 
gent, this  property  depending  upon  the  presence  of  tannic 
and  gallic  acids,  as  they  contain  35  per  cent,  of  tannic  and  5 
per  cent,  of  gallic  acids.  The  powder,  which  is  obtained 
from  the  small,  round,  dark-blue  or  lead-colored  excrescences^ 
is  of  a  light  yellowish-gray  color,  inodorous  and  of  a  bitter  taste. 

Galls  are  used  in  various  forms,  such  as  powder,  tincture, 
infusion,  ointment,  etc. 

Therapeutic  Uses. — Galls  are  employed  in  the  treatment  of 
chronic  diarrhoea,  dysentery,  leucorrhoea,  chronic  gonorrhoea 
and  gleet,  diseases  of  the  uterus  and  intermittent  fevers,  and 
externally  in  hemorrhagic  disorders,  hemorrhoids,  relaxation 
of  uvula,  hypertrophy  of  the  tonsils,  etc. 

Gallic  acid  is  given  directly  for  internal  hemorrhage. 


GALLIC  ACID.  185 


Dose. — Of  powdered  galls,  gr.  x  to  gr.  xx.  The  ointment 
is  composed  of:  powdered  galls,  gr.  Ixxx;  benzoated  lard,  5j. 
It  is  combined  with  opium  in  the  proportion  of  ointment  of 
galls,  5j ;  powdered  opium,  gr.  xxxij. 

Medical  Properties  and  ActioTi. —  Gallic  acid  is  a  powerful 
astringent  for  arresting  hemorrhage  in  which  the  bleeding 
vessels  must  be  reached  through  the  circulation.  It  is  also  a 
valuable  styptic  in  cases  of  hemorrhage  depending  on  a 
hemorrhagic  diathesis,  and  in  the  form  of  a  gargle  it  is  very 
serviceable  in  acute  inflammations  of  mucous  membranes.  It 
is  also  a  strongly  deodorizing  agent;  and,  like  tannic  acid,  it 
is  capable  of  taking  oxygen  from  the  globules.  Internally 
employed  it  produces  constipation,  which  may  be  prevented 
by  an  occasional  aperient.  Although  it  is  weaker  than  tannic 
acid,  yet  its  properties  are  very  similar.  It  is  supposed  to  be 
converted  into  tannic  acid  in  the  blood. 

Therapeutic  Uses. — Gallic  acid  is  employed  in  the  treatment 
of  hemorrhagic  diseases,  in  their  chronic  stages  especially, 
such  as  haemoptysis,  hemorrhage  from  ulcer  of  the  stomach, 
haematemesis  and  haematuria,  atonic  menorrhagia ;  also,  for  the 
profuse  perspirations  and  excessive  expectoration  of  phthisis, 
for  albuminuria,  dyspepsia,  chronic  diarrhoea  and  gastric  irri- 
tation in  children,  gonorrhoea,  gleet,  etc. 

Dose. — Of  gallic  acid,  gr.  ij  to  gr.  v,  in  pill,  every  two  or 
three  hours. 

Glycerite  of  gallic  acid  {Glyceritiim  Acidi  Gallici),  for  ex- 
ternal use,  is  composed  of  gallic  acid,  5j ;  glycerine,  .5iv. 

Ointment  of  galls  ( Ungiientiwi  Gallce)  is  composed  of  galls 
in  fine  powder,  5j ;  lard,  420  grains. 

Dental  Uses. — Powdered  galls  is  useful  as  a  styptic  in  super- 
ficial hemorrhages  from  the  gums  and  mucous  membrane; 
also  in  inflamed  and  ulcerated  conditions  of  mucous  membrane, 
and  in  relaxation  of  the  uvula.  Gallic  acid,  in  the  form  of  a 
gargle,  is  employed  in  acute  inflammations  of  mucous  mem- 
brane, as  astringent  and  antiseptic,  and  in  hemorrhages  from 
mucous  surfaces  depending  upon  a  hemorrhagic  diathesis. 

For  hemorrhage  following  the  extraction  of  teeth,  Dr.  Bar- 


186  DENTAL   MEDICINE. 

tholomew  claims  that  one  teaspoonful  of  gallic  acid  in  a  glass 
of  water,  iaternally  administered,  never  fails. 

DENTAL   FORMULA. 

For    Acute     Tonsillitis   and    Inflamma-  An    Internal    Astringent    in  Hemor- 
tion  of  the  Mucous  Membrane  of  rhagic  Affections. 

the  Mouth.  R.     Acidi  gallici    .    .    .    ^j 
R .     Acidi  gallici  ....      gr.xl  Glycerini    ....    ,^  iv 

Liq.  sodse  chlorinatse     ^ij  Aquae  destillatae    •    §vj.        M. 

Glycerini ^^ij  SiGNA. — Take  ^j  as  a  dose. 

Aquae  destillatse    .    .       §viij         M. 
SiGNA. — To  be  used  as  an  antiseptic  and 

astringent  gargle.  An   Internal    Astringent    for  Dental 

Hemorrhage. 
For  Relaxation  of  Uvula   and  Hypertro-  Otto  ARNOLD. 

phy  of  Tonsils.  R ,     Acidi  gallici    .    .    •     ^  j 

R.     Infusi  gallse ^vj  Aquse  cinnamon  .    .  ^ij.         M. 

Aluminis gr.xl.        M.  SiGNA. — A  teaspoonful  every  hour  un- 

SlGNA. — Use  as  a  gargle.  til  bleeding  is  arrested. 

For  an  Astringent  Gargle  or  Lotion. 

R .     Pulveris  gallse ^  ss 

Aquse Oj.  M. 

SiGNA. — As  a  gargle  or  lotion  in  inflamed  or  ulcerated  condition  of 
mucous  membrane  and  gums. 

ACIDUM  HYDROBROMICUM— HYDROBROMIC  ACID. 

Formula. — H  Br. 

Derivation. — Diluted  Hydrobromic  Acid  is  prepared  by  add- 
ing ten  per  cent,  of  absolute  hydrobromic  acid  to  ninety  per 
cent,  of  water.  It  is  a  clear,  colorless  liquid,  having  no  odor, 
but  a  decidedly  acid  taste  and  an  acid  reaction. 

Medical  Properties  and  Therapeutic  Uses. — Hydrobromic 
acid  is  often  substituted  for  the  bromides  on  account  of  its  pos- 
sessing many  of  their  properties.  It  is  employed  in  cerebral 
disorders  from  over-exertion,  epilepsy,  spasmodic  cough,  an- 
gina pectoris,  affections  of  the  heart,  as  it  diminishes  its  action, 
to  relieve  the  symptoms  of  quinine,  and  also  of  morphine,  mi- 
graine or  sick  headache,  neuralgia,  spasmodic  asthma,  etc. 

Dose. — TTlxx  to  5ij. 

Dental  Uses. — Diluted  Hydrobromic  Acid  may  be  employed 
in  facial  neuralgia,  infantile  convulsions  due  to  teething,  and 


HYDROCHLORIC  ACID.  187 

to  lessen   the   irritability   of  the  fauces  when  impressions  for 
obturators  and  artificial  palates  are  being  taken. 

ACIDUM  HYDROCHLORICUM— HYDROCHLORIC  ACID. 
MURIATIC  ACID=ACIDUM  MURIATICUM. 

Formula. — HCl.     Sp.  gr.  1.16. 

Derivation. — Hydrochloric  or  Muriatic  Acid  is  obtained  by 
the  action  of  sulphuric  acid  on  a  solution  of  chloride  of  sodium 
or  common  salt.  When  pure,  it  is  a  transparent,  colorless 
liquid,  but  when  contaminated  with  chlorine,  iron  and  other 
substances,  it  has  a  yellow  color.  It  emits  a  dense,  white 
vapor,  with  a  pungent  odor  and  a  corrosive  taste,  being  an  ac- 
tive poison.     The  antidote  is  magnesia  or  soap. 

Medical  Propej'ties  and  Action. — The  strong  acid  is  a  power- 
ful caustic  and  escharotic;  also  disinfectant  and  fumigant,  but 
inferior  in  its  disinfectant  properties  to  those  of  chlorine.  For 
internal  use  the  dilute  acid,  which  is  tonic,  refrigerant  and  as- 
tringent, is  employed,  acidum  hydrochloricum  dilutum — 
diluted  hydrochloric  acid,  which  is  prepared  by  diluting  the 
strong  acid  so  that  four  ounces  of  the  acid  are  contained  in  a 
pint  of  diluted  acid.  It  is  of  a  deep  yellow  color,  and  emits 
the  odor  of  chlorine,  which  is  its  principal  constituent. 

Therapeutic  Uses. — The  dilute  hydrochloric  acid  is  internally 
employed  in  the  treatment  of  calculous  affections,  gout,  atonic 
dyspepsia,  typhus  and  typhoid  fevers,  continued  fevers  of  child- 
hood, syphilis,  chronic  whooping  cough,  phthisis,  etc.,  and 
externally  in  diphtheria,  ulcerated  sore  throat,  cynanche  ma- 
ligna, etc. 

Dose.—0(  dilute  hydrochloric  acid,  TTLx  to  ITLxxx,  freely 
diluted  ;  otherwise,  when  swallowed,  it  is  highly  irritant  and 
corrosive. 

Dental  Uses. — The  strong  acid  is  employed  in  the  dental 
laboratory  for  dissolving  zinc,  in  the  preparation  of  flux  for 
soldering  certain  metals. 

The  strong  acid  is  also  employed  as  a  local  application  in 
gangrenous  stomatitis  or  cancrum  oris,  forarresting  the  ulcera- 
tive process  ;  but  care  is  necessary  in  its  use,  on  account  of  its 


188  DENTAL   MEDICINE. 


powerful  action,  in  order  to  limit  its  application  to  the  parts 
on  which  il;  is  to  act.  In  mild  cases  it  should  be  diluted  with 
an  equal  weight  of  honey. 

In  aphthous  ulcerations  of  the  mouth,  in  children,  it  is  often 
a  useful  application. 

DENTAL  FORMULAE. 
For  ApkthcB.  For  Ulceration  of  Mucous  Membrane. 

R .     Acidi  hydrochlorici     l  part  R .     Acidi     hydrochlorici 

Mellis 8  parts.     M.  diluti ^'i] 

SiGNA. — Apply  with  a  camel-hair  pen-  Glycerini _^iv 

cil  Aquae  destillatse    .    .   ^x.  M. 

SiGNA. — To  be  used  as  a  gargle. 

For  Chronic  Inflammation  of  Mucous  For  Scorbutic  Gums. 

Membrane  and  Gums.  R .     Acidi     hydrochlorici 

R .     Acidi     hydrochlorici  dilut  ......  3  ss 

dilut TTlx  Mellis, 

Infusi  cinchonse  .  .  f.^iv  Aquae  rosas  .  aa  .  .  f^j.  M. 
Mellis f gj.  M.  SiGNA. — Apply  with  a  camel-hair  pen- 
Fiat  gargarysma.  cil  three  or  four  times  a  day. 

ACIDUM   NITRICUM— NITRIC   ACID. 

AQUA  FORTIS. 

Formula. — HNO3.     Sp.  gr.  1.420. 

Derivation. — Nitric  acid  is  obtained  by  the  action  of  sul- 
phuric acid  upon  nitrate  of  potash  or  soda.  When  strong  and 
pure  it  is  colorless,  but  on  account  of  the  presence  of  nitric 
peroxide  it  is  generally  of  a  yellow  color,  and  emits  acrid, 
corrosive  fumes. 

Medical  Properties  and  Action. — Pure  nitric  acid  is  a  power- 
ful caustic  and  escharotic.  and  leaves  a  permanent  stain  on  the 
cuticle.  It  is  not  employed  in  its  concentrated  form  internally, 
but  externally,  as  an  escharotic  to  destroy  warts  and  stimulate 
sluggish  sinuses;  in  a  diluted  form  it  is  employed  as  an  as- 
tringent wash  or  gargle.  The  antidotes  in  cases  of  poisoning 
are  magnesia  or  soap,  and  mucilaginous  drinks. 

Therapeutic  Uses. — The  strong  acid  is  employed  externally 
in  hospital  gangrene,  and  phagedenic  ulcerations ;  hemor- 
rhoids and  painful  hemorrhoidal  tumors,  syphilitic  condylo- 
mata, syphilitic  sore  throat,  malignant  ulcers,  obstinate  skin 
diseases,  etc. 


NITRIC   ACID.  189 


Diluted  Nitric  Acid. — Acidum  Nitricum  Di/uttim  contains 
three  ounces  of  acid  in  a  pint  of  the  diluted  acid. 

JMcdical  Properties  and  Action. — It  is  an  antalkaline,  al- 
terative, tonic  and  refrigerant,  and  has  a  very  direct  action  on 
the  liver,  and  if  its  use  is  continued  for  a  long  time  it  causes 
saliv^ation.  Like  all  mineral  acids,  it  injures  the  teeth  ;  hence, 
proper  care  should  be  taken  to  prevent  such  action,  such  as 
the  use  of  alkaline  gargles  before  and  after  taking  the  acid 
into  the  mouth,  which  should  be  done  through  a  glass  tube  or 
quill.  As  a  tonic  it  is  advantageously  employed  during  con- 
valescence and  inflammation,  and  in  cachexia  following  acute 
disease  or  habits  of  intemperance.  It  is  also  employed  as  an 
alterative  after  a  long  use  of  mercury,  as  it  increases  the 
strength  and  improves  the  tone  of  the  system.  It  is  also  val- 
uable as  a  disinfectant,  but  inferior  to  chlorine.  It  is  not  as 
agreeable  to  the  stomach  as  diluted  sulphuric  acid. 

Therapeutic  Uses. — Dilute  nitric  acid  is  employed  in  the 
treatment  of  calculous  disease,  syphilis,  chronic  hepatitis, 
chronic  diarrhoea,  constipation,  chronic  affections  of  the  spleen, 
chronic  rheumatism,  cardialgia,  whooping  cough,  intermittent 
fevers,  etc. 

Dose. — Of  diluted  nitric  acid,  gtt.  ij-xv,  three  times  a  day, 
diluted  with  water. 

Dental  Uses. — The  strong  acid,  when  mixed  with  two  parts 
of  hydrochloric  acid,  is  a  solvent  for  gold,  and  is  known  as 
aqua  regia.  It  is  also  employed  as  one  of  the  most  effectual 
caustics  in  cancrum  oris,  the  constitution  being  supported  and 
quinine  given  at  the  same  time ;  also  for  malignant  ulcers  of 
the  mouth,  and  for  devitalizing  pulps  of  teeth  when  nearly  ex- 
posed by  mechanical  abrasion,  care  being  observed  that  the 
part  of  the  surface  immediately  over  the  pulp  is  touched  with 
the  acid,  and  the  neighboring  parts  protected. 

DENTAL  FORMULA. 
For  Sloughing  and  11 1- Conditioned  Ulcers. 

R.     Acidi  nitrici lUllx- 

Aquae Oj.  M. 

SiGNA. — Apply  with  a  camel-hair  brush. 


190  DENTAL   MEDICINE. 


ACIDUM  PHOSPHORICUM— PHOSPHORIC  ACID. 

AciDUM  Phosphoricum  Dilutum — Diluted  Phosphoric  Acid, 
is  the  principal  form  in  which  phosphoric  acid  is  employed  in 
medicine. 

Formula. — H3PO4.     Sp.  gr.  1.056. 

Derivation. — Phosphorus,  a  non-metallic  element,  obtained 
from  bones,  is  a  translucent,  nearly  colorless,  wax-like  solid, 
without  taste,  and  emitting  white  vapors  when  exposed  to  the 
air.     Sp.  gr,  1.8. 

It  is  insoluble  in  water,  but  soluble  in  ether  and  in  hot  oil  of 
turpentine,  and  has  a  peculiar  smell.  It  is  nervine,  tonic  and 
stimulant  and  in  over-doses,  poisonous.  The  vapor  is  irritat- 
ing to  the  conjunctiva  and  bronchial  mucous  membrane. 

Derivation. — Diluted  Phosphoric  Acid  is  prepared  by  boiling 
phosphorus  with  nitric  acid  and  distilled  water  until  it  is  dis- 
solved, evaporating  and  re-diluting  it.  It  may  also  be  obtained 
by  dissolving  an  ounce  of  glacial  phosphoric  acid  in  three 
ounces  of  distilled  water,  afterwards  adding  forty  grains  of 
nitric  acid,  boiling  to  a  syrup,  and  diluting  with  water  until 
the  solution  measures  twelve  and  a  half  ounces. 

Medical  Properties  and  Action. — It  is  tonic  and  refrigerant, 
and,  in  large  doses,  is  a  powerful  stimulant  to  the  nervous  and 
vascular  systems.  It  can  be  detected  in  the  blood,  owing  to 
its  absorption,  and,  in  large  doses,  is  an  irritant  poison. 

Therapeutic  Uses. — Diluted  phosphoric  acid  is  employed  in 
scrofula,  dropsy,  haemoptysis,  calculous  disease,  diabetes  and 
cardialgia.  Externally  it  has  been  employed  as  a  local  appli- 
cation in  the  treatment  of  caries  of  the  bones  and  osseous 
tumors. 

Dose. — Of  dilute  phosphoric  acid,  gtt.  ij-xv,  diluted  in  sugar 
and  water. 

Dental  Uses. — As  a  local  application  in  the  treatment  of 
caries  of  the  maxillary  bones  and  osseous  tumors  of  the  jaws. 
Internally,  it  has  been  administered  with  a  view  of  supplying 
a  deficiency  of  phosphoric  acid  in  the  teeth.  (  See  Hypophos- 
phites  of  Lime.) 


PHOSPHORIC  ACID.  191 


DENTAL  FORMULAE. 
For  Caries  of  the  Maxillary  Bones  and  For  Ulcers  over  Carious  Bones. 

Osseous   Tumors  of  the  Jaw.  g ,     Acidi  phosphorici  gla- 

R.  Acidi  phosphor,  dilut.  .    I  part  cialis ^:^j 

Aquae  destillatae  .  8  to  lo  parts.     M.  Aquae  destillatse     .     .  f5viij. 

SlGN.\. — Apply  as  a  lotion  or  injection.  Fiat  solutio. 

SiGNA. — To  be  applied  on   compresses 
to  ulcers  situated  over  carious  bones. 

Phosphoric  Acid  in  the  anhydrous  state  consists  of  one 
equivalent  of  phosphorus  to  five  equivalents  of  oxygen  (PO5), 
and  it  is  obtained  by  the  direct  union  of  its  constituents,  which 
takes  place  when  phosphorus  is  burned  in  perfectly  dry  oxy- 
gen gas. 

Thus  procured  it  is  in  the  form  of  a  white  amorphous 
powder,  extremely  deliquescent,  volatilizable  at  a  red  heat,  and 
assumes,  when  it  cools,  after  fusion,  a  vitreous  appearance. 

Glacial  Phosphoric  Acid,  or  monohydrated  phosphoric  acid, 
is  readily  obtained  from  calcined  bones,  by  first  heating  them 
with  sulphuric  acid,  which  produces  an  insoluble  superphos- 
phate of  lime ;  then  dissolving  out  the  latter  salt,  and  saturating 
it  with  carbonate  of  ammonia,  which  generates  phosphate  of 
ammonia  in  solution,  and  finally  obtaining  the  phosphate  of 
ammonia  by  evaporating  it  to  dryness,  and  then  igniting  it  in  a 
platinum  crucible.  The  ammonia  and  all  of  the  water,  except 
one  equivalent  for  each  equivalent  of  the  acid,  are  driven  off, 
and  the  glacial  phosphoric  acid  remains,  the  formula  of  which 
is  HO,P05,  and  contains  1 1.2  per  cent,  of  water.  It  is  a  white, 
transparent  fusible  solid,  generally  in  the  form  of  sticks,  inodor- 
ous and  sour  to  the  ta.ste.  It  slowly  deliquesces,  and  is  spar- 
ingly soluble  in  water,  but  freely  soluble  in  alcohol. 

Dental  Uses. — Glacial  phosphoric  acid  and  white  oxide  of 
zinc  formed  into  an  anhydrate,  give  the  plastic  material  for 
filling  teeth,  known  as  oxy-phosphate  of  zinc.  The  powder  or 
solid  portion  of  this  preparation  is  prepared  by  packing  pure 
oxide  of  zinc  in  a  clay  crucible  and  subjecting  it  to  almost  a 
white  heat  for  two  hours,  when  it  will  have  been  reduced  in 
bulk  fifty  per  cent.  It  is  then  pulverized  in  a  mortar  to  an 
almost  impalpable  powder.     The  burning  of  the  oxide  of  zinc 


192  DENTAL   MEDICINE. 


colors  it  to  a  light  yellow,  and  it  is  now  in  a  condition  for  use, 
and  may  be  kept  in  a  covered  vessel  for  any  length  of  time. 

The  liquid  portion  of  this  filling  material  being  glacial  phos- 
phoric acid,  is  prepared  by  dissolving  the  acid  in  pure  water 
until  a  saturated  solution  is  obtained,  when  it  is  reduced  by 
boiling  in  a  glass  vessel  until  it  is  of  the  consistency  of  glycerine, 
in  which  operation  it  loses  one-third  in  bulk.  It  is  now  ready 
for  use,  and  must  be  kept  in  a  close  glass-stoppered  bottle. 

Formula  for  Fletcher's  and  Weston's  preparations  of  oxy- 
phosphate  of  zinc  filling  materials  : — 

Fletcher's. 

Fluid.  Solid. 

Phosphoric  acid.  Basic  oxide  of  zinc. 

Phosphate  of  alumina. 

weston's. 

Fluid.  Solid. 

Phosphoric  acid.  Basic  oxide  of  zinc — 80  per  cent. 

{^See  Oxide  of  Zinc ^  SiUcate  of  alumina — 20    "     " 

Medicated  Oxy phosphate  Fillings. — Dr.  Chas.  B.  Atkinson 
claims  the  following  advantages  for  such  filling  material : 

First. — A  remedial  agent  in  constant  contact  with  the  walls 
of  the  cavity. 

Second. — Germicidal  action  of  the  filling  on  the  tissue  with 
which  it  comes  in  contact. 

Third. — A  neutral  influence  resisting  solution. 

Fourth. — Increased  hardness,  varying  somewhat  with  the 
agent  used.  The  medicaments  for  oxyphosphate  fillings  are  ; 
I.  Creasote  and  oil  of  cloves,  equal  parts;  2.  Eugenol ;  3. 
Deliquesced  Carbolic  acid;  4.  Oil  of  cinnamon;  5.  Oil  of 
cloves  ;  6.  Creasote,  pure;  7.  Creasote,  oil  of  cloves  and  iodo- 
form; 8.  Creolin;  9.  Campho-phenique ;  10.  Potassium  chlo- 
rate (powdered) ;  II.  Salicylic  acid;  12.  Camphor  (pulverized); 
13.  Stick  sulphur  (pulverized) ;  14.  Iodoform;  15.  Oilofwin- 
tergreen.  The  first  seven  have  been  fairly  tested  by  Dr.  At- 
kinson and  were  found  to  be  equal  in  durability,  manipulative 
qualities  and  time  of  setting.  He  employs  them  also  in  re- 
taining inlays,  in  setting  retaining-fixtures  in  pyorrhoea  cases, 
in  setting  crowns,  etc.     In  capping  pulps  he  always  employs 


SALICYLIC   ACID.  193 


a  mixture  of  oxide  of  zinc,  creasote  and  oil  of  cloves,  and  adds 
a  remedial  agent  to  the  oxy-phosphate  filling.  He  employs 
mostly  the  first-named  on  the  list.  If  the  medicament  is  a 
liquid  he  adds  about  an  equal  quantity  of  the  medicament  and 
phosphoric  acid;  if  a  powder,  about  equal  parts  of  the  medica- 
ment and  oxide.  The  proportions  may  be  varied  as  required. 
The  average  time  of  setting  is  about  ten  minutes. 

ACIDUM  SALT CYLICUM— SALICYLIC  ACID. 

Fortmila. — HC7H5O3  or  QH^j^^g^jj}. 

Derivation. — Salicylic  Acid  is  obtained  by  combining  car- 
bolic acid  with  caustic  soda,  and  subjecting  this  compound  to 
dry  carbonic  acid  under  the  influence  of  heat,  the  portion  of 
salicylate  of  sodium  remaining  behind  after  the  carbolic  acid 
distills  over  being  saturated,  m  the  form  of  a  hot,  aqueous 
solution,  with  muriatic  acid,  which  liberates  the  salicylic  acid 
in  small  crystals.  The  crystals  are  washed,  dissolved  in  hot 
water,  and  by  re-crystalization,  obtained  in  the  form  of  a 
powder  of  a  light  brown  color,  which  is  then  bleached  until 
it  is  quite  white ;  but  most  of  that  sold  is  of  a  light  cream- 
color,  with  a  reddish  tinge.  The  coloring  matter,  however, 
which  is  present,  does  not  interfere  with  its  efficacy.  It  has 
no  smell,  a  slight  taste  and  is  soluble  in  alcohol  and  ether 
and  in  hot  water  and  glycerine.  It  can  also  be  obtained  from 
salicin,  the  vegetable  principle  existing  in  willow,  poplar,  etc., 
and  from  oil  of  gaultheria  (winter  green)  and  from  spiraea 
ulmariae  (meadow  sweet). 

Medical  Properties  and  Action. — Salicylic  acid  is  a  powerful 
antiseptic,  and  is  said  to  be  as  effective  in  small  quantities  as 
any  other  antiseptic,  in  arresting  the  putrefactive  and  fermen- 
tative process.  When  properly  reduced  in  strength,  it  causes 
no  pain  or  irritation  in  the  parts  to  which  it  is  applied.  It 
will  destroy  minute  organisms,  and  a  small  quantity  will  arrest 
vinous  fermentation  and  prevent  the  decomposition  of  animal 
fluids.  Although  free  from  any  poisonous  action  when  ad- 
ministered in  a  reasonable  quantity,  yet  in  large  doses  it  will 
cause  nausea  and  vomiting.  It  is  thought  to  combine  with 
13 


194  DENTAL   MEDICINE. 


the  soda  of  the  blood,  where  it  is  present  as  a  salicylate.  It 
has  little  or  no  affinity  for  cold  water,  but  the  addition  of  cer- 
tain alkaline  salts,  such  as  sodium  phosphate,  increases  its 
solubility.  Combined  with  sulphite  of  sodium,  which  is  also 
antiseptic,  and  water,  a  solution  is  formed  which  is  free  from 
irritating  properties,  and  especially  applicable  to  the  treatment 
of  zymotic  diseases.  Glycerine  warmed  will  dissolve  -^  its 
weight  of  salicylic  acid,  and  the  solution  may  then  be  diluted 
with  water  to  any  desirable  extent. 

Therapeutic  Uses. — It  is  employed  in  fevers  as  an  antipyretic 
or  febrifuge ;  also  for  the  same  purpose  in  acute  rheumatism, 
pneumonia,  phthisis,  diphtheria,  etc.  Externally  it  is  employed 
as  a  disinfectant  and  deodorizer,  many  preferring  it,  on  account 
of  its  freedom  from  odor,  to  carbolic  acid.  It  is  also  em- 
ployed as  a  local  application  in  eczema  of  the  head  and  face, 
syphilitic  ulcers,  and  to  cancer,  gangrenous  and  sloughing 
wounds,  in  the  form  of  powder,  and  as  an  ointment  for  burns. 

Salipyrme. — Prof.  Dr.  von  Hosengeil  (Bonn,  Germany) 
claims  that  the  action  of  antipyrine  in  such  cases  of  influenza 
which  show  no  rise  of  temperature  is  that  of  a  cardiac  poison. 
Salicyl  and  quinine  have  also  such  action.  By  combining  sali- 
cylic acid  and  antipyrine  he  claims  to  have  found  a  prepara- 
tion which  he  names  salipyrine,  which  has  proven  itself  to  be 
a  most  excellent  specific  anti-influenzic  remedy  in  just  such 
cases.     The  dose  he  employs  is  from  15  to  30  grains. 

Dose. — Of  salicylic  acid,  gr.  x  to  gr.  xx  or  xxx. 

Dental  Uses. — Salicylic  acid  is  employed  in  the  treatment 
of  suppurating  and  gangrenous  pulps  of  teeth,  in  the  form  of 
the  dry  powder  introduced  into  the  pulp  canals  and  permitted 
to  remain  for  several  days.  An  ethereal  solution  of  salicylic 
acid,  introduced  on  a  small  piece  of  punk,  has  also  been  em- 
ployed for  the  same  purpose,  where  it  is  difficult  to  introduce 
the  dry  powder ;  the  ether  volatilizes  in  a  few  minutes.  Sali- 
cylic acid  is  also  employed  with  advantage  in  inflamed  condi- 
tions of  the  mucous  membrane  of  the  mouth  and  gums,  and 
in  the  treatment  of  aphthae,  thrush  and  other  ulcers,  in  the 
form  of  a  solution.     For  such  purposes  its  combination  with 


SULPHURIC  ACID.  195 


powdered  cassia  or  cinnamon,  equal  parts,  is  recommended, 
to  be  applied  with  a  soft  brush.  Salicylic  acid  has  also  been 
found  efficacious  in  all  inflammatory  conditions  resulting 
from  decayed  and  dead  teeth  and  roots.  It  has  also  been  rec- 
ommended as  a  dentifrice,  in  the  form  of  an  alcoholic  solution 
of  the  acid  perfumed  with  oil  of  gaultheria,  but  its  use  for 
such  a  purpose  is  questioned,  on  account  of  its  softening  effect 
upon  the  tooth  structure.  As  tannic  acid  interferes  with  the 
action  of  salicylic  acid,  these  agents  should  not  be  used  in 
combination. 

DENTAL    FORMULA. 

A  Disinfectant  Mouth    Wash.  SiGNA. — Add  one   or  two  drachms  to 

B .    Acidi  salicylici    .    .    .     i  part  half  a  pint  of  warm  water. 

Sodii  phosphate  ...     3  parts 

Aquae  destillatse  ...  30  parts.  M. 
SiGNA. — Use  as  a  gargle. 

A  Disinfectant  and  Stimulant  Mouth 
Wash. 
B .     Acidi  salicylici     .    .     5  ij 

Spiriti  vini  rectificati     ^x.  M. 

SiGNA. — Use  as  a  gargle. 

For  Perspiration  of  Hands  and  Feet. 
R .     Acidi  salicylici   .    .     3  parts 

Magnesii  silicat  .    .  87  parts.     M. 
SiGNA. — Use  in  the  form  of  a  powder. 

An  Emollient  and  Antiseptic  Gargle.  For  Alveolar  Pyorrhoea. 

R.     Acidi  salicyli      •    •  ^ij  R-     Acidi  salicylici  .    .    .  ^j 

Sodii  boratis    .    .    .  ^iij  Eucalyptol     .    .    .    .  ^^vi.        M. 

Glycerini     .    .    .    .  ^  iiss  Signa. — Apply  to  pockets  by  means  of 
Aquae  destillatae  .    .  ^  iij            M.  cotton  or  a  broach. 

ACIDUM  SULPHURICUM— SULPHURIC  ACID. 

OIL   OF   VITRIOL. 

Formula,  H2SO4.     Sp.  gr.  1.843. 

Derivation. — Sulphuric  Acid  is  obtained  by  burning  sulphur, 
mixed  with  one-eighth  of  its  weight  of  nitre,  over  a  stratum 
of  water  contained  in  a  chamber  lined  with  lead.  It  is  a  dense, 
colorless  liquid,  inodorous,  with  an  acrid  taste,  oily  consistence 
and  very  corrosive.  On  the  addition  of  water,  with  which  it 
unites  in  all  proportions,  there  is  an  evolution  of  heat.     In  the 


For  Warts. 

UNNA. 

R  .     Acidi  salicylici  .    .  g  iij 

Creasoti _:^vj 

Cerre,  or    Adipis    .    aa    . 

q.s.    to 

make   a  firm    ointment    that    ^ 

will    ad- 

here  to  the  skin. 

For  Burns. 

R .     Acidi  salicylici  .    .  ^j 

Olei  Olivse     .    .    .   1^  viij 

SiGNA. — Apply  as  a  lotion. 

196  DENTAL  MEDICINE. 


concentrated  form  it  is  only  used  externally  as  a  caustic. 
Being  an  apid,  corrosive  poison,  it  causes  death  from  asphyxia. 
The  antidote  is  magnesia  or  chalk,  or  solution  of  soap,  and 
mucilaginous  drinks  freely  administered. 

Medical  Properties  and  Action. — It  is  a  powerful  escharotic, 
and  when  applied  to  living  tissue,  the  parts  first  become  white, 
and  subsequently  a  brownish-black  color.  It  is  not  used  in- 
ternally, on  account  of  its  corrosive  action.  It  is  considered 
to  be  one  of  the  most  effective  caustics  in  the  bites  of  rabid 
animals. 

Diluted  Sulphuric  Acid — Acidum  Sulphwricum  Dilutum. 

Derivation. — It  is  prepared  by  diluting  sulphuric  acid  fSvij 
with  distilled  water  folxxvij,  and  when  the  mixture  has  cooled 
to  60°,  add  more  water  Slxxxiiiss.     Sp.  gr.  1.094. 

■  Medical  Properties  and  Action. — It  is  refrigerant,  astringent 
and  tonic.  It  is  employed  as  a  refrigerant  in  fevers ;  as  an 
astringent  for  arresting  hemorrhage  and  passive  mucous  dis- 
charges ;  and  as  a  tonic  to  improve  digestion.  As  it  is  very 
injurious  to  the  teeth,  the  proper  precautions  should  be  ob- 
served, as  in  the  case  of  all  acids  administered  as  medicines — 
such  as  alkaline  gargles  used  before  as  well  as  after  their  intro- 
duction in  the  mouth,  and  the  use  of  a  glass  tube  or  quill. 

Therapeutic  Uses. — Diluted  sulphuric  acid  is  employed  as  an 
internal  remedy  in  hemorrhage  from  the  lungs,  bowels  and 
uterus,  in  calculous  affections,  certain  skin  diseases,  diarrhoea, 
profuse  perspiration  of  phthisis,  in  the  advanced  stages  of 
typhus  and  typhoid  fevers,  scarlatina,  lead  poisoning,  etc. 
Externally  as  a  gargle  and  wash  to  ulcers. 

Dose. — Of  diluted  sulphuric  acid,  ITlv  to  1TLxx,  three  times  a 
day,  in  water. 

Aromatic  Sulphuric  Acid — Acidum  Sulphuricum  Aromati- 
cum — Elixir  of  Vitriol. 

Derivation. — Aromatic  sulphuric  acid  is  prepared  by  mixing 
sulphuric  acid  fSiij,  with  rectified  spirit  Oij,  and  adding  cin- 
namon §ij,  and  ginger  Si^^^.  It  is  a  reddish-brown  liquid, 
with  an  aromatic  odor  and  a  pleasant  taste. 

Medical  Properties  and  Action. — It  is  tonic  and  astringent, 


SULPHURIC   ACID.  I97 


and  is  the  most  agreeable  form  of  sulphuric  acid  for  internal 
use. 

Therapeiitic  Uses. — Aromatic  sulphuric  acid  is  employed  as 
a  substitute  for  the  diluted  form  in  debility  with  night  sweats, 
loss  of  appetite  during  convalescence  from  fevers,  haemoptysis 
and  other  hemorrhages,  and  epidemic  dysentery.  Externally 
it  is  applied  to  carious  bone,  ulcers,  in  the  treatment  of 
pyorrhoea  alveolaris,  especially  where  there  is  necrosis  of  the 
alveolar  walls,  when  it  is  applied  on  cotton  packed  in  the 
pockets ;  also  in  chronic  alveolar  abscesses.  For  such  pur- 
poses it  must  be  kept  in  the  pockets,  sinuses  and  abscesses  for 
several  hours  in  order  to  insure  its  full  effects.  It  is  also 
employed  locally  in  cancrum  oris  and  gangrene  of  the  mouth, 
and  largely  diluted,  it  forms  an  efficient  astringent  mouth- 
wash in  simple  stomatitis,  etc. 

Dose. — Of  aromatic  sulphuric  acid,  TTlv  to  Tllxxx,  three 
times  a  day,  in  water. 

Dental  Uses  of  the  Different  Forms  of  Snlphiiric  Acid. — The 
concentrated  sulphuric  acid  is  employed  as  a  caustic  in  malig- 
nant ulcers,  cancrum  oris,  gangrene,  etc.,  in  the  form  of  a 
paste,  made  by  mixing  it  with  powdered  sulphate  of  sine.  The 
concentrated  sulphuric  acid  is  also  used  in  the  dental  labora- 
tory, to  cleanse  metal  plates,  preparatory  to  and  after  solder- 
ing, for  which  purpose  it  is  generally  diluted  with  one-third  of 
water,  its  action  being  greater  when  it  is  in  a  warm  state.  The 
concentrated  acid  is  also  used  in  combination  with  nitric  acid 
to  reduce  hemp  paper  to  pyroxylin,  in  the  preparation  of  the 
celluloid  base. 

The  aromatic  sulphuric  acid  is  similar  in  its  action  to  the 
diluted  form,  and  is  more  agreeable  for  use   about  the  mouth. 

It  is  a  valuable  application  in  pyorrhoea  alveolaris  (Riggs' 
disease),  and  in  caries  and  necrosis  of  the  maxillary  bones,  as 
an  injection  or  lotion,  as  it  stimulates  the  parts  to  healthy 
action  by  favoring  granulation.  It  may  be  applied  to  parts 
about  the  teeth,  in  cases  of  recession  of  the  gums  and  absorp- 
tion of  the  processes,  on  a  properly-shaped  piece  of  orange 
wood.    It  is  also  valuable  in  alveolar  abscesses  as  an  injection, 


198  DENTAL   MEDICINE. 


especially  in  sluggish  cases,  when  the  addition  of  a  few  drops 
of  tincture  "of  capsicum  will  prove  serviceable.  It  has  the 
power  of  dissolving  the  thin,  carious  portions  of  the  bones, 
such  as  the  margins  of  the  alveolar  cavities,  and  can  be  applied 
on  cotton  saturated  with  it  and  permitted  to  remain  for  several 
hours,  when  the  parts  should  be  perfectly  cleansed  with  warm 
water.  It  is  also  employed  as  a  gargle,  properly  diluted,  in 
mercurial  inflammation  of  the  mouth  and  other  forms  of  sto- 
matitis, which  do  not  yield  to  the  influence  of  milder  astrin- 
gent washes.  It  is  also  employed  in  the  treatment  of  aphthae 
and  other  ulcers  of  the  mouth. 

Dr.  W.  H.  Atkinson  speaks  very  favorably  of  the  action  of 
aromatic  sulphuric  acid  upon  morbid  growths  and  ulcerating 
surfaces,  especially  in  pockets  where  the  connective  tissue  has 
been  destroyed  and  deep  chasms  exist  along  the  line  of  teeth, 
between  the  cementum  and  alveolar  walls.  After  drying  out 
such  pockets  with  bibulous  paper,  drops  of  sulphuric  acid,  in 
full  strength,  should  be  dropped  into  the  open  mouth  of  the 
pocket  until  it  stands  full,  on  a  level  with  the  surface  of  the 
gum  and  teeth.  This  is  repeated  when  the  contents  of  the 
pocket  is  absorbed,  again  and  again ;  after  which  the  mouth 
is  washed  with  a  saturated  solution  of  bicarbonate  of  soda  in 
distilled  water.  After  drying  the  pocket  with  bibulous  paper, 
a  paste  of  tannin  and  glycerine,  smoothly  spread  upon  several 
folds  of  the  same  paper,  is  laid  over  the  surface,  and  the  patient 
directed  to  use  hydronaphthol  solution  as  a  mouth-wash,  fre- 
quently during  the  day.  The  following  day,  the  pocket  is 
washed  out  with  Chas.  Marchand's  peroxide  of  hydrogen,  fif- 
teen volume  medicinal,  until  it  ceases  to  bubble ;  then  repeat 
the  application  of  the  aromatic  sulphuric  acid  in  the  same 
manner  as  first  described.  The  hydronaphthol  solution  should 
be  used  frequently,  and  also  a  bichloride  of  mercury  solution, 
three  or  four  times  a  day,  until  there  is  no  longer  any  evidence 
of  pus  when  the  peroxide  is  injected. 


SULPHUROUS   ACID.  199 


DENTAL  FORMULA. 

For  Mercurial  and  Ulcerative  Sto-  For  Aphthce  and  other  Ulcers  of 

matitis — (THOMAS).  Mucous  Membrane  and  Gums. 

R.     Acidi  sulphurici    .    ,    •  TTt'^  R-     Acidi  sulphuric!  .    .    .    .  f5ss 

Decocti  hordei  .    .    .    .  f5iv  Mellis f^j.      M. 

Mellis f^ss.    M.  Signa. — To  be   applied  with  a  camel- 

SiGNA. — Use  as  a  gargle.  hair  brush. 

For  Alveolar  Pyorrhoea.  For  DiarrhcBa  during  Dentition. 

Dr.  a.  W.  Harlan.              -  If  the  stools  are  serous  and  alkaline. 

R.     Acidi  sulphurici  .    .    .  TTLxxx  Dr.  James  W.  White. 

Essence  cinnamon.   .    .  ^ss  R.     Acidi  sulph.  aromat.  .    .  gtt.  viij 

Aquse ^ss.       M.  Spt.  vini  gallici  .    .    .    .  f^ij 

SiGNA. — Inject  with  a  sjTinge  one  or  Syr.  acacije 

two  minims  in  each  pocket  if  Aquae  menth.  pip.  aa.    .  f^ss.      M. 

they  are  deep  and  sinuous,  or  Signa. — A  teaspoonful  every  two  hours 

carious ;  repeat  every  4th  day.  in  a  little  water. 

For  Carious  Bone,  Riggs'  Disease,  etc. 

R.     Acidi  sulphurici  aromat f<5"i 

Tinctura   capsici gtt.x 

Aquae fgii.    M. 

SiGNA. — To  be  used  as  an  injection  or  lotion. 

ACIDUM  SULPHUROSUM— SULPHUROUS  ACID. 

Formula. — HjSOg. 

Derivation. — Sulphurous  Acid  is  made  by  dissolving  sul- 
phurous anhydride  (SOo)  in  water,  The  latter  is  made  by 
burning  sulphur.  It  is  a  colorless  liquid,  having  the  suffo- 
cating odor  of  burning  sulphur,  and  a  sour,  astringent  taste* 

Medical  Properties  and  Action. — It  is  a  deodorizer  and  dis- 
infectant, and  destructive  to  micro-organisms,  such  as  bacteria, 
fungi,  etc. 

Owing  to  its  affinity  for  oxygen  it  acts  upon  organic  matter 
with  great  energy. 

Therapeutic  Uses. — The  diluted  acid  is  locally  applied  to 
ulcers  of  the  tonsils  in  diphtheria,  syphilitic  and  tuberculous 
laryngitis,  chilblains,  parasitic  skin  diseases,  ill-conditioned, 
sloughing  or  gangrenous  wounds;  also  used  in  pyrosis,  indi- 
gestion, etc. 

Also,  in  the  form  of  inhalations  of  the  sulphurous-acid  gas, 
in  cases  of  chronic  bronchitis,  etc.  In  the  form  of  spray,  it 
is  used  as  a  local  application  in  diseases  of  air  passages. 


200  DENTAL  MEDICINE. 


Dose. — Of  sulphurous  acid,  TTL  v  to  5j. 

Dental  Uses. — Dilute  sulphurous  acid  is  efficacious  in  mer- 
curial stomatitis,  aphthae,  and  mucous  patches,  gangrene  of 
the  mouth,  cancrum  oris,  ulcers  of  mucous  membrane,  and 
sloughing  wounds.  It  is  an  efficient  and  convenient  disin- 
fectant. 

For  Chilblains.  For  Destroying  Parasites  in  Skin  Diseases. 

Bartholow.  Startin. 

R .     Acidi  sulphurosi     .    .    .  3  iij  R .     Acidi  sulphurosi,  dil.  .    .  ^  ss 

Elycecint ^^j  Sodii  hyposulphitis  .  .    .  ^iij 

Aquse §iss.  M.  Aquse,  q.  s.  ad ^xvjM. 

SiGNA. — ^Apply  as  a  lotion.  Signa. — Apply  as  a  lotion. 

ACIDUM  TANNICUM— TANNIC  ACID. 
TANNIN. 

Formula. — (Z^W^^j. 

Derivation. — Tannic  Acid  is  obtained  by  exposing  powdered 
galls  to  a  damp  atmosphere  for  several  days,  when  sufficient 
ether  is  added  to  form  a  soft  paste,  which  is  allowed  to  stand 
for  twenty-four  hours.  It  is  then  subjected  to  pressure  as 
quickly  as  possible,  and  the  mass  again  treated  with  ether,  to 
which  y^g-  of  its  bulk  of  water  has  been  added ;  this  is  allowed 
to  stand  as  before,  and  is  again  subjected  to  pressure.  The 
expressed  liquids  are  now  combined  and  allowed  to  evaporate 
spontaneously  ;  then,  by  the  aid  of  a  little  heat,  brought  to  a 
syrupy  consistence,  when  it  is  dried .  on  plates  in  a  hot  air 
chamber,  at  a  temperature  not  exceeding  212°  F.  Pure  tannic 
acid  is  solid,  uncrystallizable,  either  white  or  slightly  yellow- 
ish, inodorous,  astringent  to  the  taste,  but  without  bitterness, 
and  with  an  acid  reaction.  It  is  obtained  in  the  form  of  vesic- 
ular masses,  or  thin,  glistening  scales,  or  in  the  shape  of  fine 
threads  of  a  pseudo-crystalline  appearance.  Tannic  acid 
exists  also  in  rhatany,  catechu,  and  other  vegetable  astrin- 
gents, as  it  is  their  chief  principle. 

Medical  Properties  and  Action. — Tannic  acid  is  considered 
to  be  the  most  active  of  all  vegetable  astringents  and  styptics, 
and  especially  powerful  on  albumen,  gelatin  and  fibrin.  It  is 
very  soluble  in  water,  and  less  so  in  alcohol  and  ether.    Taken 


TANNIC  ACID.  201 


internally,  it  produces  no  nausea,  is  perfectly  safe,  and  its  use 
may  be  continued  for  a  long  time  without  any  ill  effects.  It 
may  also  be  administered  before  and  after  meals,  at  all  times, 
and  be  combined  with  many  other  remedies,  such  as  iron, 
cod-liver  oil,  bitters,  etc.  Like  gallic  acid,  it  is  capable  of 
taking  oxygen  even  from  the  blood  globules,  when  in  contact 
with  alkalies. 

Tannic  acid  is  converted  into  gallic  acid  in  the  blood,  by 
absorbing  oxygen  from  the  red  corpuscles ;  this  absorption 
does  not  occur  in  the  stomach. 

Tannic  acid  unites  with  albumen,  fibrin  and  gelatin,  forming 
insoluble  tannates,  thus  preserving  the  parts  beneath  from  the 
influence  of  irritating  agents  until  resolution  occurs. 

Its  solution  reddens  litmus  paper,  and  it  is  decomposed  and 
entirely  dissipated  when  thrown  upon  red-hot  iron. 

Therapeutic  Uses. — Internally  it  is  administered  in  hemor- 
rhages of  the  lungs,  stomach,  kidneys  or  uterus,  chronic 
bronchial  catarrh,  phthisis,  after  softening  has  taken  place, 
intermittent  fever,  whooping  cough,  chronic  diarrhoea,  diseases 
of  the  genito-urinary  organs,  dyspepsia,  diphtheria,  nervous 
diseases,  etc.  Externally  it  is  applied  to  hemorrhages  and 
profuse  secretions,  mercurial  salivation,  diseases  of  the  eye, 
nasal  polypus,  gonorrhoea  and  gleet,  bed  sores,  relaxation  of 
uvula,  skin  diseases,  ulcers,  etc. 

Dose. — Of  tannic  acid,  gr.  j  to  3j,  in  pill. 

Dental  Uses. — In  dental  practice  tannic  acid  is  a  valuable 
agent  for  local  use  in  the  treatment  of  such  diseases  as  mer- 
curial stomatitis,  ulceration  of  the  gums  and  mucous  mem- 
brane of  the  mouth,  hypertrophy  of  the  gums,  hemorrhage 
following  the  extraction  of  teeth  and  wounds  of  mucous  mem- 
brane, fungous  growth  of  pulp,  sensitive  dentine,  sponginess 
of  the  gums,  for  the  temporary  relief  of  odontalgia,  disease  of 
the  antrum.  In  mercurial  salivation  tannic  acid,  in  the  form 
of  powder,  moistened  with  water,  will  render  the  spongy  gums 
firmer  and  more  comfortable,  causing  contraction  of  the  ves- 
sels and  checking  a  tendency  to  absorption  and  the  conse- 
quent loosening  of  the  teeth.     A  strong  solution  of  tannin  in 


202  DENTAL   MEDICINE. 


alcohol  is  beneficial  in  obtunding  the  sensitiveness  of  dentine, 
or  the  tannin  may  be,  in  the  form  of  a  powder,  combined  with 
morphine  and  creasote.  Tannic  acid,  in  the  form  of  a  paste 
or  ointment,  made  by  rubbing  two  scruples  of  tannin  with 
twenty  drops  of  glycerine,  and  then  with  an  ounce  of  lard, 
makes  a  good  astringent  application.  A  gargle  composed  of 
tannic  acid  and  glycerine  is  a  useful  application  for  abrasions 
caused  by  artificial  teeth  and  other  irritants.  A  preparation 
known  as  Elixir  of  Vitriol  and  Tannin,  saturated  solution,  is 
a  powerful  astringent  and  haemostatic  when  applied  to  bleed- 
ing surfaces,  fungous  growths,  etc. 

An  English  preparation  known  as  Styptic  Colloid,  is  a  satu- 
rated solution  of  tannin  and  gun  cotton,  and  is  highly  recom- 
mended for  its  styptic  and  deodorizing  properties,  as  it  solidifies 
blood  and  albumen  by  mere  contact,  and  can  be  applied 
directly  by  means  of  a  camel-hair  brush,  or,  mixed  with  an 
equal  quantity  of  ether,  in  the  form  of  spray.  No  irritation 
follows  its  use,  and  for  hemorrhage  from  the  extraction  of 
teeth,  or  in  the  treatment  of  necrosed  or  carious  maxillary 
bones,  it  is  very  efficient.  Cold  or  warm  water  will  not  dis- 
solve it,  but  an  ether  and  alcohol  solution  may  be  used  to 
remove  the  dressing. 

Tannic  acid,  as  an  internal  remedy,  has  also  been  success- 
fully administered  for  checking  hemorrhage  after  tooth-extrac- 
tion. Dr.  W.  L.  Roberts  says  :  Tannic  acid,  administered 
internally  in  proper  doses,  will  stop,  I  believe,  any  case  of 
such  hemorrhage,  in  from  thirty  minutes  to  one  and  one-half 
hours'  time.  He  recommends  three  grains  of  tannic  acid  in 
one-third  glass  of  water,  giving  as  a  dose  two  teaspoonfuls  of 
the  solution  every  five  minutes  until  three  doses  are  taken ; 
then  two  teaspoonfuls  every  fifteen  minutes  if  required.  Dr. 
Roberts  further  says,  that  such  treatment  has  never  failed 
him. 

A  styptic  and  antiseptic  cotton  can  be  prepared  by  saturat- 
ing purified  cotton  with  tannic  acid  5  parts ;  carbolic  acid  4 
parts ;  alcohol  50  parts.  The  cotton  should  be  dried  and 
preserved  air-tight. 


TANNIC  ACID. 


203 


Glycerite  of  tannic  acid — Glyceritum  Acidi  Tannici,  for  ex- 
ternal use,  is  made  of  tannin,  5ij ;  glycerine,  5viij. 

Ointment  of  tannic  acid — Uiiguenhim  Acidi  Tannici,  is  made 
of  tannin,  5j ;  lard,  Sj.  Useful  for  a  local  application  to 
ulcers. 

DENTAL  FORMULAE. 


For  an  Astringent  Dentifrice. 

R.     Acidi  tannici gr.  xxx 

Cretse  preparatae  .  .  .  .  ^  ij 
Pulveris  ossis  sepioe  .  .  .  3  ij 
Olei  caryophylli  .    .    .  gtt.  iij.    M. 

For  Inflamed  Mucous  Membrane,  Abra- 
sions, Ulcers  and  Sensitive  Dentine, 

R .     Acidi    tannici "T^x) 

Tincture  amicse  .  .  .  .  3  ij 
Tincture   myrrhae   .    .    .   §j.    M. 

SiGNA. — To  be  used  as  a  lotion. 

For  same  as  above. 

R.     Acidi  tannici    ,    ,    .    .    3Jto  ^ij 
Spiriti  rectificati  .    .    .    .    ^j 
Aquae  destillatre  .    .    .    .   ^x.  M. 

SiGNA. — To  be  used  as  a  gargle. 

For  Inflamed  and  Ulcerated  Mucous 
Membrane, 

R.     Acidi   tannici zss 

Spiriti  vini  rectificati  .    .  5  ss 
Aquae  camphorse .   .    .    .  f^v.  M. 
SiGNA. — To  be  used  as  a  gargle. 

For  Inflamed  and  Ulcerated  Gums, 

R .     Acidi  tannici 3  iv 

Glycerini gij.     M. 

SiGNA. — To   be   used   as   a   gargle    or 

mouth-wash. 


For  same  as  above. 
R .     Acidi   tannici 
Tinct.  iodinii  , 
Potassii  iodidi 
Tinct.  myrrhae 
Aqua    rosae  . 
SiGNA. — A  dessert-spoonful  in  a  wine- 
gla.ss  of  water   as   a  mouth- wash  or 
gargle. 


.  gr.  XX 
f.^viij.  M. 


For  Inflamed  Mucous  Membrane  of 
Alouth. 
R.     Acidi  tannici  .    .    .    .   ^ij 

Pulveris  aluminis  .    .  gr.xxx 
Aquae  destillatae     .    .   ^  v.  M. 

SiGNA. — To  be  used  as  a  gargle. 

For  Sensitiveness  following  the  Removal 
of  Salivary  Calculus. 
Coleman. 
R  .     Acidi  tannici  ...       ^^  ss 

Eau  de  Cologne     .    .  f  5  iv.       M. 

SiGNA. — Add   10  or  12  gtts.  of  above 

solution    to   a  teaspoonful    of    tepid 

water,  and  use  as  a  gargle   3   or  4 

times  a  day. 


For  Loose  Teeth  and  Spongy  Gums, 


R. 


Acidi  tannici  . 
Potassii  iodidi 
Tinct.  iodi 
Tinct.  myrrhas 
Aquae  rosas     . 


3JSS 

gr.xii 
I) 


M. 


Dissolve  the  tannic  acid  and  iodide  of 
potassium  in  the  rose  water  and  add 
the   tinctures  and  strain. 
SiGNA. — A  teaspoonful  in  a  wine-glass 
of  warm  water,  used  every  morning 
as  a  mouth  wash. 
For  an  Astringent  Mouth    Wash  in  In- 
flamed  and    Ulcerated  Conditions    of 
Gum  and  Mucous  Membrane. 
R .     Acidi  tannici  .    .    .    .  gr.  xx 
Tincturae  pyrethri  .    .  ^iij 
Aquae  rosae     .    .    .       ^vj.        M. 
SiGNA. — To  be  used  as  a  gargle. 

For  Ulcerations  and  Abrasions. 
R .     Acidi  tannici  .    .    .    .  gr.  xv 

Glycerini f^j.  M. 

SiG.N'A. — To  be  used  as  a  lotion. 


204 


DENTAL   MEDICINE. 


R. 


For  Inflamed  Mucous  Membrane  of 
Mouth. 

Acidi  tannic!  .    .    .    •  ^  ss 
Sodii  boratis  .    .    .    .   ^iij 


For  Alveolar  Hemorrhage. 

R .     Acidi  tannici  .    .    .    .  gr.  xl 
Liq.   plumb,    subacet. 

dilut f  ^  iss 

Vin.  opii f^^s.       M. 

SiGNA. — Apply  on  cotton  or  lint,  or  as 
an  injection. 

For  Chronic  Ulcers  and  Abscesses. 
Berel. 
R.     Acidi  tannici       .    .    .  gr.  xxxij 

Aquae  destillatse     .    .  f  ^viij.     M. 
SiGNA. — To  be  used  as  a  lotion. 

Astringent  and  Antiseptic  Gargle. 

R.     Tannin 5  grammes. 

Tincture  iodine  .    . 
Tincture  myrrh  .  aa  2^  grammes. 
Iodide  of  potassium  i  gramme. 
Rose  water     .    .    .180  grammes. 
M. 
SiGNA. — A  teaspooonful  in  a  glass   of 
water. 

ACIDUM   TARTARICUM— TARTARIC   ACID. 

Formula. — HgQH^Og. 

Derivation. — Tartaric  Acid  is  obtained  from  ''tartar"  (a 
peculiar  substance  which  concentrates  on  the  inside  of  wine 
casks,  being  deposited  during  the  process  of  fermentation),  or 
from  crude  cream  of  tartar. 

It  is  in  the  form  of  white  or  colorless  crystals,  irregular, 
six-sided  prisms,  and  is  soluble  in  water  and  alcohol,  and 
wholly  dissipated  by  heat. 

Medical  Properties  and  Action. — It  is  refrigerant,  and  dis- 
solved in  water  and  sweetened,  is  a  good  substitute  for  lem- 
onade. 

In  large  doses  it  is  an  irritant  poison,  and  when  its  internal 
use  is  followed  by  a  red  and  dry  tongue,  it  should  be  discon- 
tinued. It  is  often  administered  in  the  form  of  effervescing 
powders. 

Therapeutic  Uses. — Internally  it  is  employed  as  a  refriger- 
ant   in   inflammatory  and  febrile  diseases,  irritability  of  the 


\_riyceiuii ^  ij 

Aquse  destillatae     .    .  §iv. 

M. 

SiGNA. — Use  as  a  gargle. 

For  Inflamed  Mucous  Membrane 

of 

Mouth  and  Fauces. 

R .     Acidi  tannici  .    .    .    ,  gj 

Tinctura  myrrhse    .    .   g  iij 

Pulv.  acacise  .    .    .    .  ^ij 

Glycerini ^ij 

Aq.  destil.  q.s.ad  .    .  ^vj. 

M. 

SiGNA. — Use  as  a  gargle. 

For  Odontalgia. 

Druitt. 

R .     Acidi  tannici  .    .    .    .  gr.  xx 

Gum  mastich  .    .    .    .  gr.  x 

Spt.  aether  sulph    .    .  f^ss. 

M. 

SiGNA. — To  be  applied  to  carious  cavity, 

on  a  pellet  of  cotton. 

ACONITE.  205 

stomach,  nausea  and  vomiting,  dyspepsia,  and  diseases  at- 
tended with   copious  secretion  of  mucus,  dysentery,  etc.,  etc. 

Dose. — Of  tartaric  acid,  gr  x  to  gr.  xx,  dissolved  in  water 
and  sweetened. 

Dental  Uses. — In  combination  with  an  equal  quantity  of 
chloride  of  lime,  it  is  employed  for  bleaching  discolored  teeth. 

ACONITUM— ACONITE. 
WOLFSBANE.  MONKSHOOD. 

Source. — Aconite  is  obtained  from  the  dried,  tuberous  root 
of  Aconitum  Napellus,  a  perennial  plant  abounding  in  the 
mountains  of  Europe  and  Asia.  The  leaves  and  root  are  both 
used,  but  the  latter  is  the  most  powerful.  The  alkaloid 
Aconitia  or  Aconitme,  a  sedative  poison,  is  obtained  from  the 
root,  and  is  externally  employed  for  neuralgic  affections,  pro- 
ducing a  sensation  of  heat  and  pricking,  succeeded  by  a  feel- 
ing of  numbness  and  constriction  in  the  part  on  which  it  is 
rubbed ;  and  very  satisfactory  results  have  been  obtained 
from  the  internal  administration  of  Duquesnel's  Aconitia,  in 
neuralgia  of  the  fifth  pair  of  nerves.  Another  principle  of 
aconite,  suggested  by  Duquesnel,  is  known  as  Napelline, 
which  is  less  powerful  than  aconitia,  but  possesses  important 
hypnotic  properties,  and  is  substituted  for  opium  and  chloral, 
especially  in  cases  of  wakefulness  and  mental  excitement 
during  neuralgic  attacks. 

Medical  Properties  and  Action. — Aconite  is  a  powerful  seda- 
tive to  the  nervous  system,  and  reduces  the  force  of  the 
circulation.  In  large  doses  it  is  an  active  poison,  lessening 
the  heart's  action,  affecting  its  ganglia  and  muscle,  and  par- 
alyzing the  muscles  of  respiration.  In  moderate  doses  it  pro- 
duces warmth  in  the  stomach,  general  warmth  of  the  body, 
and  sometimes  nausea,  numbness  and  tingling  in  the  limbs 
and  fingers,  muscular  weakness,  diminished  force  and  fre- 
quency of  the  pulse  and  diminished  respiration.  It  proves 
fatal,  in  poisonous  doses,  by  its  powerfully  sedative  impression 
on  the  nervous  system,  by  suspension  of  the  respiratory  func- 
tion and  by  syncope. 


206  DENTAL   MEDICINE. 


Therapeutic  Uses. — Aconite,  in  the  form  of  an  extract  pre- 
pared from  the  leaves,  and  a  tincture  prepared  from  the  root, 
is  administered  in  all  inflammatory  and  febrile  affections,  acute 
rheumatism,  neuralgia,  especially  in  chronic  cases  of  neuralgia, 
where  all  the  signs  of  active  disease  are  absent,  or  have  been 
relieved  by  other  remedies ;  tetanus,  sciatica,  diseases  of  the 
heart,  erysipelas,  amenorrhoea,  tonsillitis,  acute  congestion  of 
liver,  peritonitis,  eruptive  fevers,  etc.,  etc.  It  is  contra-indi- 
cated in  inflammatory  conditions  of  the  gastro-intestinal  mu- 
cous membrane.  It  is  locally  applied  to  painful  sprains  and 
bruises,  and  chronic  arthritic  swellings. 

Dose. — Of  the  tincture  of  aconite — tinctura  aconiti—^\X.  j 
to  gtt.  v ;  of  the  extract  of  aconite — extractum  aconiti — gr.  j 
to  gr.  ij.  The  tincture  of  the  root  is  composed  of  twelve  troy- 
ounces  to  alcohol  Oij.     Dose  of  aconitia,  gr.  yto- 

Dental  Uses. — Aconite,  in  the  form  of  the  tincture,  is  a  val- 
uable agent  in 'dental  practice.  When  locally  applied  it  checks 
inflammation  in  its  early  stages,  by  paralyzing  the  nerves  of 
the  part  and  lessening  the  excitement  to  the  local  afflux  of  blood, 
favoring  resolution  and  limiting  the  extent  of  an  abscess  where 
pus  is  already  formed.  Combined  with  an  equal  part  of  the  tinc- 
ture of  iodine,  it  is  a  valuable  application  in  the  incipient  stages 
of  periodontitis,  as  it  relieves  the  inflammation  by  retard- 
ing the  circulation  and  stimulating  lymphatic  action.  For  such 
purpose  the  gum  or  root  of  the  affected  tooth  should  be  painted 
with  this  combination  until  it  assumes  a  dark  brown  color,  taking 
the  precaution  to  first  remove  all  moisture  from  the  surface  to 
which  it  is  to  be  applied,  and  after  its  application,  protecting  the 
adjoming  parts,  such  as  the  lips  or  cheeks,  until  the  remedy  is  ab- 
sorbed. A  drop  or  two  of  the  tincture,  introduced  into  the  cavity 
of  an  aching  tooth,  will  relieve  odontalgia ;  and  the  same  quan- 
tity will  subdue  the  pain  which  follows  the  extraction  of  a  tooth, 
especially  when  the  cause  has  been  the  inflammation  of  the 
peridental  membrane.  Tincture  of  aconite  is  also  serviceable 
in  the  conservative  treatment  of  irritated  or  inflamed  pulps  of 
teeth.  Combined  with  an  equal  quantity  of  chloroform,  it  is 
applied  as  a  local  anaesthetic  for  the  extraction  of  teeth.     For 


ACOXITE. 


207 


the  same  purpose  it  is  combined  with  chloral,  pyrethrum, 
morphia,  etc.  (See  Dental  Formulae.)  It  is  also  a  useful 
dressing  for  the  pulp  canals  of  teeth,  preventing  the  forma- 
tion of  inflammatory  products.  The  alkaloid,  acoiiitia,  is  a 
useful  remedy  in  neuralgia  of  the  fifth  pair  of  nerves.  (See 
Dental  Formulae).  Care  is  necessary  in  the  application  of  the 
tincture  of  aconite  to  large  surfaces,  or  where  the  skin  is 
abraded,  as  dangerous  constitutional  effects  may  result. 
Fifteen  drops  of  the  tincture,  taken  internally,  have  caused 
death.  The  symptoms  of  poisoning  by  aconite  are  as  fol- 
lows :  Overpowering  sense  of  fatigue  in  the  lower  extremities, 
great  muscular  weakness,  dimness  of  vision,  with  diluted 
pupils ;  great  dyspnoea,  the  respirations  being  short  and  la- 
bored ;  the  pulse  at  first  slow  and  small,  and  afterward  imper- 
ceptible ;  surface  of  body ;  tongue  and  breath  cold  ;  a  profuse 
perspiration  ;  muscles  of  respiration  paralyzed  ;  ceasing  of  the 
heart's  action.  The  antidotes  are  emetics  and  stimulants — 
heat,  brandy  and  ammonia ;  keep  flat  on  back. 

DENTAL  FORMULA. 

For  Neuralgia.  A  Local  Anasthetic  for  the  Extraction 

R.    Pulveris  radicis  aconiti    ^x  -^             ' 

Camphone gss  R.    Tincturse  aconiti     .    .  ^iss 

Spiriti  rectificati  .    .    .  q.s.  Pyrethri :?  iij 

Moisten  the  aconite  with  some  of  the  VeratrinEe gr.x 

alcohol  and  macerate  in  a  close  ves-  Morphinge  sulphas      .  gr.iv 

sel  for  3  days,  then  percolate  slowly  Spiriti  rectificati  .    .    .   ,^  iv 

into  a  receiver  containing  the  camphor  Chloral  hydratis  .    .    .  gr.iv         M. 

until   the   product   measures    half    a  Let  it  stand  4  days  and  then  filter. 

P'"t-  SiGNA. — Apply  to  the  gum  over  root  of 

SiGNA. — Apply  with  a  camel-hair  brush.  tooth  to  be  removed  for  sixty  seconds, 

by  means  of  an  applicator. 
For  Odontalgia. 

R .    Tinctune  aconiti, 

r^,       r       ■  r     ■■■                    For  u  Local  AitcBstlutic  for  Extraction 

Chloroformi .    .  aa  .  .fsui.                                              ^  ™    ,, 

.  .  •'    ■'                                                 of   Teeth. 

Tmct.  capsici  .    .    .  .  f^j 

Tinct.  pyrethri.,  R.    Tinctura  aconiti  .    .    .  f.^j- 

01.  caryophylli  .  aa  .  f.f  ss  Menthol K'-x- 

Gum  camph    .    .    .    .   ^ss.         M-  Chloroformi     ....  f;^].         M. 

SiGNA. — To  be  applied  on  a  pallet  of  Signa. — Apply   freely    to    gum   about 

cotton.  tooth  for  several  minutes. 


208 


DENTAL   MEDICINE. 


For  Neuralgia    and  Rheumatic  Pains^ 

Bruises,  Etc, 
R .    Tincturse  aconiti, 
Chloroformi  venalis, 
Spiriti  ammonise  .  aa  .  f^ij 

Oleo  ricini ^i 

Linimenti  saponis  .    •  f^j-  M. 

SiGNA. — To  be  rubbed  on  the  affected 
part. 

For  Neuralgia  of  Fifth  Pair  of  Nerves. 
(For  internal  use.) 

R.    Aconitse gr.J^ 

Glycerini, 

Alcohol    ,    .  aa  .    .    .  ^j 

Aquse  menthse  pip  .    .   ^ij.  M. 

Dose. — A  teaspoonful. 

For  Neuralgia, 
R .    Linimenti  aconiti, 

Lin.  belladonnse  .  aa  .  ^vij 

Chloroformi     .    .    .    .  ^ij.         M. 

SiGNA. — Apply    on    lint,    to  the   part 

affected,  and  cover  with  a  fine  piece 

of  sponge  saturated  with  warm  water. 

For  Trigeminal  Neuralgia.     * 
R.    Aconitinse    (Duques- 

nel's)    ...     ...  gr.3-V 


Glycerini 

Alcohol     .    .    aa   .    .  ^j 
Aquae  menthae  pip  .    .  ,^  ij  M. 

Dose. — A  teaspoonful,  slowly  and  cau- 
tiously increased  to  y%. 

For  Periodontitis, 
R .    Tincturse  iodi, 

Tincturae  aconiti,  .  aa    ^ss.         M. 
SiGNA. — Apply  to  gum  over  root  of  af- 
fected tooth  with  a  camel-hair  brush. 

To  Abort  an  Abscess, 
Dr.  Geo.  Watt. 
R .    Ext.  aconiti,  fl. 

Ext.  belladonnse,  fl. 
Ext.  opii.,  fl    .  aa  .  equal  parts.  M. 
SiG. — Apply  with   brush  as  needed  to 
ease  pain;  also  give  fluid  extract  of 
phytolaccse  internally. 

For  Odontalgia,  Internal  Treatment, 

Dr.  Dunogier. 
R.    Aconitine  (crystallized)  ^  milligr. 

Gelsemine I  milligr. 

Valerianate  of  quinine  .    5  centigr. 
For  one  pill. 
M.  S. — One  to  three  pills  to  an  adult 
in  the  24  hours. 


^THER— ETHER. 
iETHER    SULPHURICUS SULPHURIC    ETHER. 

Formula.  —  QHjoO.  Sp.  gr.  —  Of  pure  ether,  .0713:  of 
stronger  ether,  0.728 ;  of  ordinary  officinal  ether,  0.750. 

Derivation, — Sulphuric  Ether  is  obtained  by  the  distillation 
of  alcohol  and  sulphuric  acid,  and  is  rectified  byre-distillation 
with  solution  of  potassa.  The  form  of  sulphuric  ether  em- 
ployed for  inhalation  is  still  further  purified  by  agitation  with 
water,  and  it  is  freed  from  this  and  from  an  excess  of  alcohol 
and  deleterious  acid  substances  by  the  action  of  chloride  of 
lime  and  freshly  calcined  lime,  when  it  is  known  as  stronger 
ether — ^ther  Fortior.  Sp.  gr.  0.728.  Sulphuric  ether  is  a 
colorless,  limpid,  volatile  and  inflammable  fluid,  with  a  sweet 


ETHER.  209 

odor  and  a  hot.  pungent  taste ;  on  account  of  its  great  vola- 
tility, it  should  be  kept  securely  in  ground-glass-stoppered 
bottles.  It  usually  reddens  litmus  paper  slightly;  when  it  does 
so  strongly,  the  ether  is  impure.  The  impurities,  besides  acids 
and  fixed  substances,  are  heavy  oil  of  wine,  an  excess  of  alco- 
hol and  water.  Acids  being  detected  by  litmus  paper,  may  be 
removed  by  agitation  with  potassa ;  fixed  substances  may  be 
removed  by  evaporating  the  ether.  Some  alcohol  is  always 
found  in  ether,  and  it  is  only  when  it  is  present  in  too  great  a 
quantity  that  the  density  of  the  ether  is  rendered  too  high. 
The  quantity  of  alcohol  any  preparation  of  ether  may  contain, 
can  be  determined  by  agitating  it  in  a  minim  measure  with 
half  its  volume  of  a  concentrated  solution  of  chloride  of  cal- 
cium. This  will  remove  the  alcohol,  and  the  reduction  of  the 
volume  of  ether  when  it  rises  to  the  surface  will  indicate  the 
amount  of  alcohol  which  has  been  present.  Heavy  oil  of  wine 
can  be  detected  by  the  ether  becoming  milky  when  mixed  with 
water.  Ether  boils  at  98°  F.,  and  a  cold  of  166°  below  zero 
will  not  freeze  it.  When  kept  too  long  it  undergoes  decom- 
position, and  is  converted  in  part  into  acetic  acid. 

It  evaporates  so  readily  and  completely  in  the  air  as  to  cause 
a  great  degree  of  cold ;  hence  it  has  been  employed  in  the  form 
of  spray,  as  a  local  anaesthetic.  It  combines  with  alcohol  and 
chloroform  in  all  proportions,  and  dissolves  in  ten  times  its 
volume  of  water. 

Medical  Properties  and  Action. — Ether  is  a  diffusible  stimu- 
lant, antispasmodic,  anodyne  and  anaesthetic.  It  is  administered 
internally  in  the  form  of  ether  or  of  Hoffmann's  Anodyne, 
compound  spirit  of  ether — Spiritus  Etheris  Compositus  (com- 
posed of  ether,  Oss,  ethereal  oil,  f5vj,  and  alcohol,  Oj),  also, 
in  the  form  of  spirit  of  nitrous  ether,  Spiritus  Etheris  Nitrosi, 
and  known  as  sweet  spirit  of  nitre  (a  solution  of  nitrous  ether 
in  alcohol). 

When  ether  is  taken  into  the  stomach,  it  causes  a  cooling 

sensation,  after  the  subsidence  of  the  burning,  which  is  quickly 

diffused  over  the  body ;  increased  action  of  the  heart,  flushing 

of  face  and  warmth  of  surface  follow  in  a  k\v  minutes;  the 

»4 


210  DENTAL   MEDICINE. 


senses  are  quickly  excited ;  the  mind  becomes  more  active, 
and  the  phenomena  of  alcohohc  intoxication  result,  which 
soon  pass  away,  leaving  a  feeling  of  calmness  and  sleep. 

Therapeutic  Uses. — Ether  is  employed  internally  as  an  anti- 
spasmodic and  anodyne,  for  angina  pectoris,  hysteria,  asthma, 
flatulence,  cramp  of  stomach  and  bowels,  syncope,  epilepsy, 
hiccough,  nervous  or  hysterical  headache.  Hoffmann's  Aqo- 
dyne  possesses  the  antispasmonic  and  stimulating  effects  of 
ether,  and  the  anodyne  effects  of  ethereal  oil,  or  oil  of  wine, 
and  is  also  carminative. 

The  Spirit  of  Nitrous  Ether  is  antispasmodic,  diaphoretic, 
and  diuretic,  and  is  employed  in  febrile  affections,  dropsies, 
etc.,  etc. 

Dose — Of  ether,  f5ss  to  foj ;  of  Hoffmann's  Anodyne,  foss 
to  f5ij,  in  sweetened  water;  of  spirit  of  nitrous  ether,  fSss  to 
f§ss. 

Dental  Uses. — Ether  is  employed  as  a  general  and  local 
anaesthetic ;  as  a  topical  anodyne  in  neuralgia  and  odontalgia, 
for  which  purpose  it  is  generally  combined  with  other  agents  ; 
in  aphthse  and  stomatitis  ;  as  a  counter-irritant,  evaporation 
being  prevented. 

Sulphuric  Ether  as  an  Anesthetic  Agent. — Sulphuric 
ether  is  generally  considered  to  be  a  safer  anaesthetic  agent 
than  chloroform,  as  but  comparatively  few  deaths  have  resulted 
from  its  inhalation.  The  discovery  of  its  anaesthetic  properties 
was  first  made  in  1844,  by  Dr.  Horace  Wells,  a  practicing 
dentist,  of  Hartford,  Conn. ;  and  Dr.  Morton,  of  Boston,  also 
a  dentist,  first  demonstrated  the  application  of  its  anaesthetic 
properties  in  dentistry  and  surgery,  in  1846. 

As  the  physiological  actions  of  both  ether  and  chloroform 
are  similar,  they  may  be  considered  as  follows :  When  the 
vapor  of  ether  or  chloroform  is  inhaled,  the  first  effect  is  faucial 
irritation,  to  a  greater  or  less  degree,  according  to  the  strength 
of  the  agent  employed,  a  feeling  of  suffocation,  with  cough,  a 
flow  of  mucus  and  the  reflex  act  of  swallowing.  The  desire 
for  air  may  cause  more  or  less  struggling,  especially  in  the 
case  of  children.      The  sensibility  of  the   glottis,   however, 


ETHER— ANESTHESIA.  211 


is  soon  relieved,  the  cough  ceases,  and  the  inhalation  of  the 
agent  proceeds  without  further  resistance. 

The  primary  effect  is  a  general  exhilaration  ;  and,  in  the  case 
of  ether  especially,  it  is  often  one  of  excitement,  which,  in  the 
majority  of  cases,  may  continue  for  a  short  time  only,  while 
in  other  cases,  it  may,  from  its  duration  and  violence,  give  rise 
to  considerable  trouble.  But,  if  the  inhalation  can  be  con- 
tinued and  this  stage  of  excitement  passed  over,  insensibility 
soon  occurs.  The  pulse  increases  in  frequency,  the  respira- 
tions become  more  rapid,  and  may  assume  a  convulsive  char- 
acter. There  is  flushing  of  the  face,  cerebral  intoxication,  to 
a  greater  or  less  degree,  according  to  the  temperament,  such 
as  talking,  laughing,  singing,  crying,  etc.  In  those  of  a  mer- 
curial or  hysterical  disposition  this  stage  of  excitement  is  more 
pronounced  and  persistent,  and  during  its  continuance  sensi- 
bility to  pain  is  considerably  diminished,  although  the  sense 
of  touch  is  still  preserved,  while  those  of  taste  and  smell  are 
lost,  and  complete  insensibility  soon  follows. 

When  the  patient  is  of  a  full  habit,  and  in  robust  health, 
and  the  inhalation  of  the  anaesthetic  agent  has  been  rapid,  the 
stage  of  complete  insensibility  is  preceded  by  a  convulsive 
stage,  during  which  there  is  rigidity  of  the  voluntary  muscles, 
stertorous  breathing  and  lividity  of  the  face.  If  the  inhalation 
of  the  agent  be  still  further  continued,  the  tetanic  rigidity  of 
the  muscles  subsides,  the  lividity  of  the  face  disappears,  the 
breathing  becomes  quiet,  complete  muscular  relaxation  ensues, 
power  of  movement  is  lost,  as  shown  by  the  arm,  when  raised, 
dropping  without  resistance,  and  the  conjunctiva  of  the  eye, 
under  mechanical  irritation,  being  perfectly  insensible  to  pain. 
During  complete  anaesthesia  the  surface  of  the  face  is  cool  and 
bathed  in  abundant  perspiration  ;  the  countenance  is  calm,  the 
eyes  closed  and  the  pupils  somewhat  contracted,  the  respiration 
easy  and  the  pulse  slower.  The  functions  of  respiration  and 
circulation  continue,  all  others  being  suspended.  From  such 
a  condition  the  patient  will  soon  emerge,  provided  the  further 
inhalation  of  the  agent  be  stopped  ;  on  the  other  hand,  if  the 
inhalation  be  continued,  the  functions  of  respiration  and  circu- 


212  DENTAL   MEDICINE. 


lation  will  be  suspended,  and  life  will  end  with  the  cessation 
of  the  action  of  the  heart  and  the  respiratory  organs.  Sudden 
death  from  the  inhalation  of  anaesthetic  agents  is  due  to 
paralysis  of  the  cardiac  ganglia.  When  death  occurs  during 
the  stage  of  rigidity  and  stertorous  breathing,  it  is  due  to 
tetanic  fixation  of  the  respiratory  muscles  and  obstruction  of 
the  pulmonary  circulation,  accumulation  of  venous  blood  in 
the  heart  and  the  arrest  of  the  heart's  action. 

Death  may  also  ensue  by  paralysis  of  the  respiratory  mus- 
cles during  the  stage  of  complete  muscular  relaxation  ;  also 
by  paralysis  of  the  heart  during  complete  insensibility,  the 
motor  ganglia  being  paralyzed. 

Death  may  also  occur  from  depression  of  the  functions  and 
the  shock  of  the  accident,  or  of  the  surgical  operation. 

Mr.  Woodhouse  Braine  divides  anaesthetics  into  two  classes  : 
(i)  Those  which  produce  death  through  the  lungs  as  well  as 
through  the  heart ;  this  class  includes  chloroform,  bichloride 
of  methylene,  dichloride  of  ethidene,  and  many  others  of  the 
chlorine  series ;  (2)  those  which  produce  death  through  the 
lungs  alone,  the  heart's  action  continuing  for  some  time  after 
respiration  has  quite  ceased :  this  class  includes  ether  and 
nitrous  oxide ;  and  he  says,  that  in  choosing  an  anaesthetic 
three  factors  are  to  be  considered  :  (i).  The  nature  of  the 
operation ;  (2)  the  amount  of  insensibility  necessary ;  (3)  the 
length  of  time  during  which  insensibility  has  to  be  kept  up; 
and  he  sums  up  as  follows:  (i)  It  is  well  to  avoid  all  anaes- 
thetics which  tend  to  depress  the  heart's  action  :  (2)  for  short 
operations  nitrous  oxide  is  the  best  agent ;  (3)  for  long  opera- 
tions, except  where  it  is  desirable  to  avoid  hemorrhage,  or 
where  the  cautery  is  used,  ether  answers  perfectly ;  (4)  the 
best  time  for  operating  is  the  early  morning ;  (5)  nitrite  of 
amyl  is  the  best  cardiac  stimulant. 

The  Administration  of  Anesthetics. — To  administer 
ether  or  chloroform,  take  a  folded  piece  of  lint,  of  three  or  four 
thicknesses,  and  of  a  size  that  can  be  held  conveniently  in  the 
hollow  of  the  fingers  and  palm  of  the  hand  ;  and  on  it  pour 
the  anaesthetic  agent — half  an  ounce  of  ether  or  a  drachm  of 


ETHER— ANESTHESIA.  213 

chloroform.  Some  prefer  a  large  napkin  or  towel,  folded  in 
the  form  of  a  cone,  with  an  opening  of  an  inch  or  an  inch  and 
a  half  at  the  apex,  for  the  admission  of  air.  The  advantage, 
however,  of  the  lint  over  the  folded  napkin  is,  that  by  holding 
the  lint  in  the  hand  but  little  evaporation  occurs.  To  give 
sufficient  air  to  the  patient  when  begining  the  administration 
of  ether,  Dr.  D.  B.  Keefe  recommends  the  use  of  a  large  towel, 
folding  it  first  five  times  lengthwise,  and  placing  a  piece  of  paper 
the  full  length  between  the  outside  folds,  then  roll  it  up  into  a 
cylinder,  the  size  to  be  governed  by  the  face  of  the  patient : 
it  should  be  large  enough  to  cover  the  face,  but  not  too  large. 
This  makes  a  cylinder  open  at  both  ends,  full  size.  Then 
saturate  the  lower  part  of  the  cylinder,  that  comes  against  the 
face  with  the  ether  and  apply  it  to  the  face,  and  as  the  other  end 
is  open  the  patient  receives  considerable  air  as  well  as  the  ether 
vapor.  Before  commencing  the  inhalation,  the  condition  of  the 
pulse  should  be  ascertained  by  placing  the  middle  finger  of  the 
left  hand  on  the  left  temporal  artery,  and  at  the  same  time  en- 
deavor to  reassure  the  patient  and  allay  fear  by  cheerful  words. 
The  clothes  should  be  loose,  and  artificial  teeth,  if  any  are  worn, 
as  well  as  pins,  if  the  habit  of  keeping  them  in  the  mouth  is 
indulged  in,  should  be  removed  before  the  administration  of 
the  anaesthetic  is  commenced.  The  inhalation  should  be  com- 
menced by  holding  the  moistened  lint  or  towel  three  or  four 
inches  from  the  patient's  face,  directing  him  to  breathe  quite 
naturally,  always  remembering  that  a  strong  atmosphere  in  the 
early  stages  of  the  inhalation  is  dangerous,  and  carefully 
watching  for  coughing  or  acts  of  swallowing,  when,  if  any 
such  occur,  the  lint  or  towel  should  be  moved  further  away, 
and  approached  again  more  gradually.  If  the  patient  shows 
no  signs  of  the  anaesthetic  vapor  being  too  strong,  the  lint  or 
towel  may  be  gradually  brought  to  within  an  inch  and  a  half 
of  the  patient's  mouth  and  nostrils;  and  to  still  more  concen- 
trate the  atmosphere,  if  lint  is  used,  the  hand  holding  it  may 
be  covered  with  one  fold  of  an  ordinary  large  napkin,  which 
may  hang  loose  over  the  mouth  and  chin,  but  should  be  so 
arranged   above   that   the  patient's  eyes  and   forehead  may 


214  DENTAL   MEDICINE. 


remain  uncovered  and  visible.  The  inhalation  should  be  com- 
menced ca^itiously,  by  instructing  the  patient  to  breathe  quite 
naturally,  and  to  obey  any  direction  to  raise  the  hand  or  open 
the  eyes. 

When  the  inhalation  has  fairly  commenced,  it  should  be 
continued  until  there  is  no  winking  when  the  margins  of  the 
eyelids  are  touched,  or  the  hand  cannot  be  raised,  and  the  limbs 
are  perfectly  relaxed,  when  the  patient  is  ready  for  the  opera- 
tion ;  what  is  termed  the  "  surgical  period "  having  arrived. 
An  inhalation  with  chloroform  generally  takes  about  four 
minutes ;  often  more  ;  seldom  less.  With  ether,  the  time  re- 
quired is  longer  and  the  quantity  of  the  agent  greater. 

It  should  also  be  remembered  that,  in  summer,  chloroform 
and  ether  evaporate  more  readily  than  in  the  colder  seasons. 

The  operator  should  devote  his  undivided  attention  to  the 
patient,  during  the  inhalation  of  anaesthetics.  One  finger 
should  be  kept  on  the  pulse,  and  the  respiration  should  be 
carefully  noted;  for  the  latter  is  of  more  importance  than  the 
former,  although  the  pulse  is  by  no  means  to  be  neglected. 
When  the  patient  becomes  excited,  he  should  be  watched  very 
closely,  and  if  the  respiration  becomes  proportionately  quick- 
ened, so  must  the  vapor  of  the  anaesthetic  be  proportionately 
weakened,  by  withdrawing  the  lint  or  towel  slightly  from  the 
face. 

When  the  muscles  become  rigid,  and  the  patient  holds  his 
breath  and  becomes  livid,  the  anaesthetic  should  be  given  very 
weak  indeed,  as  such  a  state  of  semi-asphyxiation,  due  to  the 
suspension  of  respiration,  is  often  followed  by  extreme  rapidity 
and  depth  of  respiration,  and  a  dangerous  condition  is  apt  to 
supervene,  because  anaesthesia  is  added  to  asphyxia.  The 
cumulative  action  of  these  general  anaesthetics  should  also  be 
remembered,  for  a  state  of  narcosis  frequently  intensifies  for 
half  a  minute  or  more  after  the  suspension  of  the  administra- 
tion, which  is  due  to  the  vapor  of  the  anaesthetic  which  was 
in  the  lungs  entering  the  blood  after  the  administration 
ceases. 

Dr.  Buxton  points  out  that  even  admitting  greater  danger 


ETHER— AN/ESTHESIA.  215 

from  chloroform,  its  use  is  indicated  in  the  following  circum- 
stances : 

a.  In  protracted  operations  about  the  mouth,  jaws,  nose, 
or  pharynx,  which  necessitates  the  mouth  and  nose  being  un- 
covered. 

b.  All  operations  needing  the  employment  of  the  actual 
cautery,  or  lighted  candles,  lamps,  etc.,  in  the  vicinity  of  the 
mouth;  ether  being  highly  inflammable,  and  when' mixed  with 
air,  detonating,  so  that  the  incautious  bringing  of  the  appara- 
tus near  a  light  may  lead  to  grave  consequences. 

c.  Persons  who  are  suffering  from  bronchitis,  and  those 
liable  to  that  complaint;  the  emphysematous  (if  the  condition 
be  very  pronounced)  and,  as  a  rule,  asthmatics  bear  ether 
badly,  since  it  creates  cough,  and  may  clog  the  bronchial  tubes 
with  a  quantity  of  excessive  secretion. 

d.  In  renal  disease,  when  extensive,  ether  is  said  to  induce 
suppression  of  urine ;  so  that  if  given  at  all  in  these  cases,  it 
should  be  with  the  utmost  caution. 

e.  The  vascular  excitement  to  which  ether  gives  rise,  con- 
tra-indicates  its  use  for  persons  whose  arteries  are  presumably 
brittle,  etc. 

f.  In  infants  and  very  young  children. 

g.  As  ether  always  provokes  coughing  and  rapid  breath- 
ing, it  should  not  be  used  when  these  are  prejudicial  to  the 
patient  or  to  the  success  of  the  operation. 

h.  The  presence  of  brain  tumors,  intestinal  obstruction, 
and  cancerous  tumors  is  by  some  considered  contra-indicatory 
of  ether.  To  these  the  Chronicle  adds  two  other  large  groups 
of  conditions,  viz.:  ist,  all  cases  of  brain  surgery;  2d,  where 
the  circumstances  of  the  patient  or  the  requirements  of  the 
operation  are  such  as  to  demand  the  securing  of  perfect  rest 
by  the  free  use  of  opiates,  ether  must  be  avoided  on  account 
of  its  action  on  the  kidneys. 

Prof.  J.  J.  Chisholm,  of  the  University  of  Maryland,  gives 
the  following  five  simple  rules  for  the  administration  of  chlo- 
roform, and  which  will  apply  to  ether  also: — 

"i.     I  always,  without  a  single  exception,  give  a  strong 


216  DENTAL   MEDICINE. 


drink  of  whiskey,  from  one  to  two  ounces,  to  every  adult  to 
whom  I  intend  to  administer  chloroform.  This  is  done  a  few 
minutes  before  the  operation. 

"2.  Always  loose  the  neck  and  chest  clothing,  so  as  to 
have  no  impediment  to  respiration. 

"3.  Only  administer  chloroform  in  the  recumbent  posture, 
with  body  perfectly  horizontal  and  head  on  a  low  pillow,  this 
pillow  to  be  removed  as  the  anaesthesia  progresses. 

"4.  Give  chloroform  on  a  thin  towel,  folded  in  conical 
form,  with  open  apex,  so  that  the  vapor,  before  inhalation,  will 
be  freely  diluted  with  atmospheric  air.  In  holding  this  cone 
over  the  face  of  the  patient,  at  some  little  distance  from  the 
nose,  place  the  fingers  under  the  borders  of  the  cone,  for  the 
double  purpose  of  allowing  the  air  to  enter  freely,  and  also 
to  prevent  the  chloroform  liquid  on  the  towel  from  coming  in 
contact  with  the  skin  of  the  patient's  face,  and  thereby  avoid 
its  blistering  effects. 

"  5.  Should  loud  snoring  occur,  force  up  the  chin.  This 
manipulation,  by  straightening  the  air  passages  from  the  nose 
to  the  larynx,  makes  easy  breathing.  The  forcible  elevation 
of  the  chin  is  far  better  in  every  respect  than  pulling  out  the 
tongue.  It  is  easier  of  application,  more  quickly  done,  re- 
quires no  instrument,  and  is  much  more  efficient  in  removing 
the  impediment  to  respiration. 

"  While  operating,  I  have  constantly  in  view  both  the  color 
of  the  face  and  the  respiration  of  the  patient,  which  I  consider 
even  more  important  for  the  surgeon  to  observe  than  to  feel 
the  pulse."  (See  "  Chloroform  "  for  further  directions  and  pre- 
cautions to  be  observed  during  the  administration  of  this  agent.) 

Dr.  H.  A.  Hare  states  that  if  during  anaesthesia,  respiration 
stops,  he  has  found  that  in  a  large  number  of  instances,  both 
in  man  and  in  the  lower  animals,  the  free  use  of  ether  poured 
upon  the  belly  causes  so  great  a  shock,  by  the  cold  produced 
by  its  evaporation,  as  to  cause  a  very  deep  inspiration,  which 
is  often  followed  by  the  normal  respiratory  movements. 

Dr.  H.  I.  Neilson  gives  the  following  conclusions  concern- 
ing the  pupil  as  a  guide  in  the  administration  of  chloroform  : 


ETHER— ANESTHESIA.  217 

1.  The  first  effect  of  chloroform  narcosis  on  the  pupils 
consists  in  a  dilatation  which  varies  in  intensity  and  duration 
in  different  individuals.  As  the  anaesthesia  becomes  more 
profound  the  pupils  begin  to  contract  and  finally  become  very 
small  and  immovable.  If  now  the  chloroform  is  pushed  still 
further,  a  sudden  dilatation  occurs,  which  is  the  result  of 
asphyxia,  from  which  the  patient  seldom  recovers. 

2.  As  long  as  the  pupil  is  observed  to  dilate  in  response 
to  sensory  stimuli,  such  as  pinching  the  skin,  the  anaesthesia  is 
not  yet  sufficient  to  allow  the  commencement  of  the  operation. 

3.  As  soon  as  the  pupil  becomes  strongly  contracted  and 
immovable,  the  administration  of  the  anaesthetic  must  be  sus- 
pended until  a  commencing  dilatation  is  observed,  and  the  pa- 
tient must  be  held  at  just  this  point  as  long  as  the  operation 
continues. 

4.  Vomiting  causes  a  dilatation  similar  to  that  occurring 
as  the  patient  emerges  from  the  narcotic  condition,  but  it  is 
usually  more  sudden  in  the  former  case.  The  contraction 
of  the  pupils  does  not  appear  to  begin  until  the  blood-pressure 
is  somewhat  reduced,  and  the  dilatation  proceeds  pari  passu 
with  the  increase  in  the  blood-pressure.  He  therefore  regards 
the  appearance  of  the  pupil  as  a  very  reliable  guide  for  the  ad- 
ministration of  chloroform,  as  he  is  enabled  to  judge  accu- 
rately concerning  the  condition  of  the  patient. 

When  ether  or  chloroform  is  administered  for  the  extraction 
of  teeth,  the  operation  should  be  performed  in  a  dental  chair 
so  constructed  as  to  admit  of  the  patient  being  placed  in  as 
horizontal  a  position  as  is  possible  to  operate  successfully, 
and  every  instrument  it  is  necessary  to  use  should  be  within 
reach  of  the  hand  of  the  operator.  As  soon  as  the  operation 
is  completed  the  head  of  the  patient  should  be  gently  inclined 
to  the  side,  so  as  to  permit  the  blood  to  run  from  the  mouth 
and  not  pass  down  the  throat.  Any  considerable  change  in 
the  position  of  the  patient  should  be  avoided  until  recovery 
has  taken  place.  Fresh  air  should  be  admitted  by  lowering 
the  window,  and  the  patient  freely  supplied  with  it  by  means 
of  a  fan. 


218  DENTAL   MEDICINE. 


M.  Paul  Bert  instituted  experiments  with  mixtures  of  ether, 
chloroform  and  air,  or  nitrous  oxide  and  air,  or  nitrous  oxide 
and  oxygen,  under  pressure,  which  he  claimed  diminished 
the  danger  without  lessening  the  advantages  of  the  anaesthetic. 
A  proportion  of  eight  per  cent.,  after  six  or  seven  minutes, 
sufficed  to  induce  and  maintain  a  state  of  surgical  coma  for 
fifteen  to  thirty  minutes,  and  the  symptoms  of  the  stage  of 
exhilaration  were  much  less  marked  than  usual.  He  also 
claimed  that  there  is  an  absence  of  the  feeling  of  suffocation 
common  to  the  old  method ;  that  the  face  retains  its  natural 
color ;  that  respiration  is  regular,  but  somewhat  quickened  and 
sometimes  snoring ;  that  the  pulse  shows  no  marked  disturb- 
ance ;  that  the  buccal  secretion  is  scanty ;  that  the  patient  is 
spared  violent  coughing,  which  often  seems  to  initiate  the 
after  vomiting;  that  the  return  to  consciousness  from  complete 
anaesthesia  takes  from  eight  to  ten  minutes ;  that  the  quantity 
of  chloroform  used  is  small — in  one  case,  where  the  anaesthesia 
lasted  half  an  hour,  it  was  only  five  grammes ;  that  by  means 
of  the  apparatus  used  the  patient  escapes  any  local  irritation 
of  the  skin,  and  the  operator  does  not  receive  the  fumes  of  the 
drug  in  his  face.  The  appliance  used  in  Bert's  method  is  the 
invention  of  Dr.  H.  Martin  for  analyzing  the  gases  of  respira- 
tion, and  consists  of  a  pair  of  reservoirs  connected  with  a 
caoutchouc  mouth-piece,  and  containing  the  required  mixture 
of  air  and  chloroform.  By  a  special  contrivance  a  constant 
supply  of  the  anaesthetic  is  maintained,  to  make  up  for  the  loss 
by  inhalation,  and  the  pressure  within  the  reservoirs  remains, 
under  all  circumstances,  equal  to  that  of  the  surrounding  air  ; 
and  the  respiratory  movements  can  be  accurately  watched  by 
means  of  a  water  manometer  and  scale  affixed  to  the  instru- 
ment. In  operations  on  the  mouth,  anaesthesia  is  first  produced 
by  the  aid  of  the  mouth-piece,  and  afterward  kept  up  by  an 
occasional  jet  of  the  mixed  vapor  sent  into  the  back  of  the 
mouth. 

Some  eminent  surgeons,  however,  among  the  number 
Messrs.  Gosselin  and  Richet,  consider  Bert's  method  a  danger- 
ous one,  and  the  latter  states  of  the  cases  at  the  St.  Louis 


ETHER— ANAESTHESIA.  219 

Hospital,  Paris,  which  he  witnessed,  one  in  three  was  accom- 
panied with  vomiting,  discomfort,  and,  on  one  occasion,  with 
great  excitement. 

What  has  been  styled  "vitalized  air,"  is  the  vapor  from  a 
mixture  composed  of  equal  parts  of  chloroform  and  alcohol 
combined  with  the  nitrous  oxide  gas.  The  vapor  from  two  or 
three  drops  of  the  chloroform  and  alcohol  mixture  is  used  with 
each  gallon  of  gas,  the  anaesthetic  effect  of  which,  it  is  claimed, 
is  more  lasting,  and  at  the  same  time  less  dangerous,  than  from 
either  of  the  two  agents  alone.  An  apparatus  for  combining 
these  two  agents  is  in  use,  which  is  attached  to  the  gas  cylin- 
der, in  place  of  the  ordinary  connection. 

The  administration  of  anaesthetics  through  the  nose  has 
been  suggested  by  Dr.  B.  C.  A.  Windle,  of  England,  a  pecu- 
liar instrument  being  employed  for  pumping  the  vapor  of  the 
anaesthetic  through  a  tube  which  passes  into  one  nostril;  wings, 
to  close  the  outer  surface  of  the  nostril  containing  the  tube 
and  the  opposite  surface  of  the  septum  nasi,  are  attached  to 
the  tube,  so  that  air  may  pass  through  the  passage  unoccluded 
by  the  tube.  The  inventor  of  this  method  claims  that  by  its 
use  perfect  anaesthesia  can  be  maintained  throughout  an  opera- 
tion about  the  face,  of  any  length,  without  interfering  with  the 
operator's  actions ;  also,  that  in  operations  about  the  mouth 
and  palate  the  patient  can  be  maintained  at  that  point  of  anaes- 
thesia which  may  be  considered  desirable,  and  that  the  supply 
can  be  regulated. 

Dr.  Axel  Yversen,  of  Copenhagen,  suggested  etherization 
by  the  rectum,  the  vapor  being  conducted  to  the  rectum  by  a 
rubber  tube  (attached  to  a  bottle  containing  the  ether,  in  a 
water  bath  of  120°),  terminating  in  a  recurrent  catheter,  the 
free  or  recurrent  end  being  closed  by  pressure  of  the  thumb 
during  the  inflation  of  the  bowel ;  the  expiratory  act  being 
performed  by  removing  this  pressure  and  the  water  bath.  The 
principal  advantage  this  method  appears  to  possess  is  that  it 
permits  operations  on  the  face  without  the  ordinary  obstacles 
of  the  common  method. 

The  Dangers  of  An/esthesia. — The  conditions  rendering 


220  DENTAL   MEDICINE. 


general  anaesthetics  dangerous  are  fatty  degeneration  of  the 
heart  (a  prominent  contra-indication) ;  previous  alcoholic  habits ; 
brain  tumors  and  degenerations ;  respiratory  obstruction  from 
swollen  epiglottis,  enlarged  tonsils,  oedema  glottidis,  laryngeal 
paralysis,  thoracic  tumors  or  aneurism ;  emphysema  and  ob- 
structed pulse  circulation  from  engorgement  of  right  heart 
and  deficient  heart  power ;  valvular  lesions  ;  incomplete  anaes- 
thesia during  painful  surgical  operations,  causmg  death  from 
shock,  as  the  result  of  peripheral  irritation.  Muscular  debility 
and  weakness  from  exhaustion,  if  otherwise  uncomplicated, 
are  considered  to  be  rather  aids  to  anaesthesia  than  contra- 
indications. 

Preventive  Measures  Against  the  Dangers  of  Anaes- 
thesia.— A  thorough  examination  for  sources  of  danger  should 
always  be  made  previous  to  the  administration  of  the  anaes- 
thetic. An  anaesthetic  should  never  be  administered  on  a  full 
stomach,  as  an  anaesthesia  of  the  glottis  prevents  the  expulsion 
of  vomited  matter  from  the  larynx,  in  case  it  enters  by  regur- 
gitation. An  anaesthetic  should  never  be  administered  after 
long  fasting,  as  absence  of  nutrition  may  tend  toward  cardiac 
paralysis.  One  or  two  ounces  of  whiskey  should  be  adminis- 
tered immediately  before  the  operation.  All  excitement  should 
be  avoided,  to  the  patient,  from  fear,  sight  of  instruments,  too 
many  spectators,  etc.,  all  of  which  tend  to  induce  shock.  All 
appliances  for  resuscitation  should  be  at  hand,  and  plenty  of 
fresh  air  be  available  during  the  inhalation.  In  using  chloro- 
form mix  only  three  and  a  half  per  cent,  of  the  vapor  with  air, 
to  ensure  safety.  In  the  administration  of  ether  the  respira- 
tions, according  to  some  authorities,  alone  need  be  watched ; 
in  chloroform,  however,  both  the  respirations  and  the  pulse 
should  be  carefully  noted. 

Treatment  of  Dangerous  Symptoms  of  Anesthesia. — 
The  suspension  of  the  heart's  action  necessitates  the  immediate 
withdrawal  of  the  vapor  and  the  immediate  inversion  of  the 
patient,  according  to  Nelaton's  method.  The  failure  of  respi- 
ration necessitates  the  forcing  up  of  the  chin,  or  the  forcible 
drawing  out  of  the  tongue  to  lift  the  epiglottis  ;  the  practice  of 


ETHER— ANESTHESIA.  221 

artificial  respiration  by  the  Sylvester  method,  and  by  faradiza- 
tion of  the  respiratory  muscles  ;  the  inhalation  of  gtt.  iij  to  gtt. 
iv  of  nitrite  of  amyl;  ammonia  to  the  nostrils ;  galvanism  (the 
positive  pole  being  placed  to  the  nostril,  and  the  negative  pole 
over  the  diaphragm,  to  excite  a  reflex  action  between  the  fifth 
pair  and  the  pneumo-gastric,  or  the  poles  may  be  placed  directly 
over  both  phrenic  nerves,  on  a  line  with  the  fourth  cervical 
vertebra,  in  order  tostimulate  respirations  ;  or  one  pole  may  be 
placed  over  the  upper  dorsal  spinous  process,  and  the  other 
pole  over  the  apex  of  the  heart,  to  induce  cardiac  contraction). 
Artificial  warmth  should  be  applied,  but  no  cold  applications. 

The  inversion  of  the  body,  according  to  Nelaton's  method, 
and  artificial  respiration,  according  to  Sylvester's  method  or 
Marshall  Hall's  ready  method,  or  Howard's  method,  are  safe 
and  are  the  most  promising  expedients.  A  simple  method  of 
producing  artificial  respiration  is  as  follows  : — 

"  With  outspread  palms,  press  the  front  of  the  chest  forcibly 
down,  whilst  an  assistant  at  the  same  time  presses  the  abdo- 
men. Make  these  movements  not  oftener  than  fifteen  times  in 
the  minute." 

DR.  H.  R.  Sylvester's  method  of  resuscitation. 
"  To  Adjust  the  Patient's  Position. — Place  the  patient  on  his 
back,  on  a  flat  surface;  raise  and  support  the  head  and  should- 
ers on  a  small,  firm  cushion,  or  folded  article  of  dress,  placed 


under  the  shoulder-blades  ;  remove  all  tight  clothing  about  the 
neck  and  chest. 


222  DENTAL   MEDICINE. 


"  To  Maintain  a  Free  Entrance  of  Air  into  the   Windpipe. — 
Cleanse  the  qiouth  and  nostrils ;  open  the  mouth ;  draw  forward 


the  patient's  tongue,  and  keep  it  forward  ;  an  elastic  band  over 
the  tongue  and  under  the  chin  will  answer  the  purpose. 

"  To  Imitate  the  Movements  of  Breathing : — 

"  First,  Induce  Inspiration  Place  yourself  at  the  head  of  the 
patient ;  grasp  his  arms ;  raise  them  upward  by  the  sides  of 
his  head ;  stretch  them  steadily  but  gently,  upward  and  back- 
ward, for  two  seconds.  By  this  means  fresh  air  is  drawn  into 
the  lungs,  by  raising  the  ribs. 

"  Secondly,  Induce  Expiration.  Immediately  turn  down  the 
patient's  arms,  and  press  them  firmly,  but  gently,  downward 
against  the  sides  of  his  chest,  for  two  seconds.  By  this 
means  foul  air  is  expelled  from  the  lungs,  by  depressing  the 
ribs. 

"  Thirdly,  continue  these  Movements.  Repeat  these  move- 
ments alternately,  deliberately  and  perseveringly,  fifteen 
times  in  a  minute,  until  a  spontaneous  effort  to  respire  be  per- 
ceived. By  these  means  an  exchange  of  air  is  produced  in 
the  lungs,  similar  to  that  effected  by  natural  respiration." 

MARSHALL    HALL'S    READY    METHOD    IN   ASPHYXIA. 

"  1st.  Treat  the  patient  instantly,  on  the  spot,  in  the  open  air, 
freely  exposing  the  face,  neck  and  chest  to  the  breeze,  except 
in  severe  weather. 

"  2d.  In  order  to  clear  the  throat,  place  the  patient  gently  on 
the  face,  with  one  wrist  under  the  forehead,  that  all  fluid,  and 
the  tongue  itself,  may  fall  forward,  and  leave  the  entrance  into 
the  windpipe  free. 


ETHER— ANESTHESIA.  223 


*'  3d.  To  excite  respiration,  turn  the  patient  slightly  on  his 
side,  and  apply  some  irritating  or  stimulating  agent  to  the 
nostrils,  as  Vcratrinc,  dilute  A  vmionia,  etc. 

"  4th.  Make  the  face  warm  by  brisk  friction ;  then  dash 
cold  water  upon  it. 

"  5th.  If  not  successful,  lose  no  time;  but,  to  imitate  respira- 
tion, place  the  patient  on  his  face,  and  turn  the  body  gently, 
but  completely,  on  the  side  and  a  little  beyond ;  then  again  on 
the  face,  and  so  on,  alternately.  Repeat  these  movements 
deliberately  and  perseveringly,  fifteeti  times  only  in  a  minute. 
(When  the  patient  lies  on  the  thorax,  this  cavity  is  compressed 
by  the  weight  of  the  body,  and  ^^piration  takes  place.  When 
he  is  turned  on  the  side,  this  pressure  is  removed,  and  zVzspira- 
tion  occurs.) 

"6th.  When  the  prone  position  is  resumed,  make  a  uniform 
and  efficient  pressure  along  the  spine,  removing  the  pressure 
immediately  before  rotation  on  the  side.  (The  pressure  aug- 
ments the  ^;rpiration ;  the  rotation  commences  /aspiration.) 
Continue  these  measures. 

*'  7th.  Rub  the  limbs  upward,  with  firm  pressure  and  with 
energy.  (The  object  being  to  aid  the  return  of  venous  blood 
to  the  heart.) 

"  8th.  Substitute  for  the  patient's  wet  clothing,  if  possible, 
such  other  covering  as  can  be  instantly  procured,  each  by- 
stander supplying  a  coat  or  cloak,  etc.  Meantime,  and  from 
time  to  time,  to  excite  inspiratio?i,  let  the  surface  of  the  body 
be  slapped  briskly  with  the  hand. 

"  9th.  Rub  the  body  briskly  till  it  is  dry  and  warm,  then 
dash  cold  water  upon  it,  and  repeat  the  rubbing. 

"  Avoid  the  immediate  removal  of  the  patient,  as  it  involves 
a  dangerous  loss  of  time  ;  also  the  use  of  bellows,  or  any  forc- 
ing instrument ;  also  the  warm  bath,  and  all  rough  treatment." 

DR.  Howard's  method  of  REsucrrATioN. 

One  of  the  most  efficient,  as  well  as  the  most  recent 
method,  is  that  of  Dr.  Howard  for  performing  artificial  re- 
spiration. 


224  DENTAL   MEDICINE. 


Position  of  Patient. — Face  upward,  a  hard  roll   of  clothing 
beneath  the4:horax,  with  shoulders  slightly  declining  over  it. 


(One  twist  of  handkerchief  around  the  crossed  wrists  will 
keep  them  there.)     Rip  or  strip  clothing  from  waist  and  neck. 

Position  of  Operator. — Kneel  astride  the  patient's  hips  ; 
place  your  hands  upon  his  chest,  so  that  the  ball  of  each 
thumb  and  little  finger  rests  upon  the  inner  margin  of  the 
free  border  of  the  costal  cartilages,  the  tip  of  each  thumb 
near  or  upon  the  xiphoid  cartilage,  the  fingers  fitting  in  the 
corresponding  intercostal  spaces.  Fix  your  elbows  firmly, 
making  them  even  with  your  sides  and  hips  ;  then — 

Action  of  Operator. — Pressing  upward  and  inward  toward 
the  diaphragm,  use  your  knees  as  a  pivot,  and  throw  your 
weight  slowly  forward  two  or  three  seconds  until  your  face 
almost  touches  that  of  the  patient,  ending  with  a  sharp  push, 
which  helps  to  jerk  you  back  to  your  erect  kneeling  posi- 
tion. Rest  three  seconds,  then  repeat  this  bellows-blowing 
movement  as  before,  continuing  it  at  the  rate  of  seven  to  ten 
times  a  minute,  taking  the  utmost  care  on  the  occurrence  of  a 
natural  gasp,  gently  to  aid  and  deepen  it  into  a  longer  breath 
until  respiration  becomes  natural.  When  practicable,  have 
the  tongue  held  firmly  out  of  one  corner  of  the  mouth  with 
thumb  and  finger  armed  with  a  dry  cotton  rag. 

Very  frequently  during  the  early  stages  of  the  administra- 
tion of  an  anaesthetic  the  patient   may  "  forget  to  breathe," 


LOCAL  ANESTHESIA.  225 

even  before  the  ability  to  perceive  peripheral  irritation  is  lost. 
Even  later  in  the  anaesthesia,  when  the  breathing  suddenly 
ceases,  instead  of  using  cold  water  externally  and  slapping 
the  patient  with  wet  towels.  Dr.  H.  A.  Hare  recommends  pour- 
ing a  quantity  of  ether  upon  the  belly,  the  shock  caused  by  the 
cold  produced  by  its  evaporation  bringing  on  a  very  deep  in- 
spiration, followed  often  by  the  normal  respiratory  movements. 

Local  An.esthesia. — The  fatality  attending  the  use  of 
general  anaesthetics  led  to  the  introduction  of  what  are 
termed  "  local  anaesthetics,"  some  of  which  depend  upon  the 
therapeutic  property  of  cold,  which  is  properly  an  anaes- 
thetic only  when  it  freezes  the  part  to  which  it  is  applied. 
The  use  of  cold  for  such  a  purpose  must  necessarily  be  lim- 
ited to  small  parts  of  the  body,  and  its  utility  depends  upon 
the  ease  and  rapidity  with  which  a  desired  spot  of  living  flesh 
can  be  frozen,  in  other  words,  temporarily  deprived  of  its  vi- 
tality, without  inflicting  mechanical  injury  on  the  delicate 
structure  of  the  part. 

According  to  Dr.  Richardson,  the  proposer  of  the  method, 
the  principle  consists  in  directing  on  the  part  of  the  body  a 
volatile  liquid,  having  a  boiling  point  at  or  below  blood  heat, 
in  a  state  of  fine  subdivision  or  spray,  such  subdivision  being 
produced  by  the  action  of  air  or  other  gaseous  substance  on 
the  volatile  liquid  to  be  dispersed.  When  it  falls  on  a  part  of 
the  body,  it  comes  with  force  into  the  most  minute  contact 
with  the  surface  upon  which  it  strikes. 

As  a  result,  there  is  rapid  evaporation  of  the  volatile  fluid^ 
and  so  great  an  evolution  of  heat  force  from  the  surface  of  the 
part  to  which  the  spray  is  applied,  that  the  blood  cannot  supply 
the  equivalent  loss.  The  part  consequently  dies  for  the  mo- 
ment, and  is  insensible ;  but  as  the  power  of  the  body  is 
unaffected,  the  blood,  as  soon  as  the  external  reducing  agency 
is  withdrawn,  quickly  makes  its  way  again  through  the  dead 
parts,  and  restoration  rapidly  occurs. 

The  fluids  used  are  ether,  of  a  specific  gravity  not  exceed- 
ing 0.723,  highly  rectified,  and  as  free  as  is  possible  from  either 
alcohol  or  water — what  is  known  as  "  absolute  ether  " — and 
15 


226  DENTAL   MEDICINE. 


rhigolene,  a  product  of  petroleum,  and  the  lightest  liquid 
known,  and  bromide  of  ethyl. 

When  a  current  of  the  volatile  liquid,  either  atomized  ether 
or  rhigolene,  comes  in  contact  with  the  skin  by  the  use  of  the 
spray  apparatus,  an  intense  degree  of  cold  is  produced,  which 
deprives  the  nerves  of  the  part  of  their  power  to  transmit 
impressions  to  the  sensorium.  For  the  extraction  of  teeth, 
destruction  of  the  pulps  of  teeth,  opening  abscesses,  and  other 
minor  surgical  operations,  and  neuralgia  of  superficial  nerves, 
success  has  attended  the  use  of  such  local  anaesthetics.  The 
greatest  objections  to  such  a  method  of  inducing  local  anaes- 
thesia, are  the  great  pain  which  attends  the  first  application, 
and  the  unpleasant  burning  sensation  of  the  part  when  it  is 
recovering  from  the  freezing  process.  (See  Rhigolene.)  (See 
Aconite,  for  obtunding  mixture.) 

Liquefied  chloride  of  methyl  dissolved  in  ether  and 
carefully  applied  by  means  of  a  hair  pencil,  is  recommended 
for  the  painless  extraction  of  teeth,  the  opening  of  alveolar  ab- 
cesses,  etc.,  etc.     (See  Cocaine  as  a  local  anaesthetic.) 

A  plan  of  local  anaesthesia,  known  as  Voltaic  Narcotism,  has 
been  suggested  by  Dr.  Richardson,  of  London.  It  consists 
in  passing  a  galvanic  current  through  a  narcotic  solution  held 
in  contact  with  the  part  to  be  operated  upon.  This  plan  ap- 
pears to  be  successful  only  where  the  cavity  of  the  tooth  to 
be  extracted  is  exposed. 

Electro-magnetism  has  also  been  employed  as  a  local  anaes- 
thetic, and  it  is  a  mooted  question  whether  it  relieves  pain  or 
complicates  the  sensations.  It  is  well,  however,  to  remember 
that  some  persons  are  so  peculiarly  constituted  as  to  render 
them  very  susceptible  to  the  influence  of  electricity.  Dr. 
Scott  describes  his  method  of  applying  electricity  for  the 
extraction  of  teeth  as  follows  :  "Use  a  Kidder  electro-mag- 
netic machine,  or  any  other  giving  very  rapid  vibrations  of  ar- 
mature. Place  the  positive  electrode  on  the  gum  of  the  tooth 
to  be  extracted,  and  the  negative  in  the  patient's  hand,  or  at 
the  back  of  the  neck.  Start  with  a  light  current  and  gradually 
increase  the  strength  as  much  as  can  be  borne  without  pro- 


LOCAL  ANESTHESIA.  227 

ducing  pain.  The  electrode  applied  to  the  tooth  should  em- 
brace each  side,  the  better  to  convey  the  current.  For  this 
purpose  it  should  be  bifurcated  at  the  end  of  the  handle,  the 
arms  of  sufficient  length  for  convenience  in  operating.  At  the 
end  of  these  solder  small  disks  about  the  size  of  a  dime.  The 
handle  and  arms  must  be  insulated  to  prevent  the  current 
passing  off  at  any  other  point  than  the  disks.  Cover  the  disks 
with  thin  pads  of  fine  sponge.  A  cylinder  electrode,  also  cov- 
ered with  fine  sponge  or  cloth  is  the  proper  one  for  the  hand. 
Moisten  each  with  saline  water.  Another  method  is  to  attach 
one  pole  of  the  battery  to  the  extracting  forceps,  the  handles 
of  which  are  well  insulated,  the  other  pole  being  held  in  the 
hands  of  the  patient.  As  soon  as  the  forceps  come  in  contact 
with  the  tissues  about  the  tooth  the  circuit  is  completed,  and 
the  electrical  effect  produced,  which  is  often  painful.  A  Com- 
mittee of  the  College  of  Dentists,  England,  in  a  recent  report 
upon  the  anaesthetic  value  of  electricity,  were  unanimous  that 
in  no  case  was  local  anaesthesia  produced  by  such  currents, 
but  that  the  effects  were  due  to  "  diversion  of  sensation,  less 
difficulty  of  extraction  as  compared  with  other  extractions, 
syncope  more  or  less  marked,  and  differences  in  methods  of 
operating."     (See  Electricity  as  a  Therapeutic  Means,  etc.) 

Obtunding  mixtures,  consisting  of  a  combination  of  cocaine, 
pyrethrum,  aconite,  chloral,  veratria  and  alcohol,  or  chloro- 
form, aconite,  belladonna,  opium  and  carbolic  acid,  etc.,  have 
been  employed  to  produce  local  anaesthesia,  and  in  many  cases 
with  satisfactory  results.  (See  recipes  for  obtunding  mixtures 
and  local  anaesthetics).  For,  although  entire  insensibility  to 
pain  cannot  in  all  cases  be  brought  about,  yet  some  dimi- 
nution of  it  may  be  effected  by  the  use  of  such  agents.  They 
have  the  merit,  at  least,  of  being  less  dangerous  than  the  gen- 
eral anaesthetics.  Such  pain  obtunding  mixtures  are  best 
applied  to  the  parts  about  the  neck  and  over  the  root  of  a  tooth 
by  means  of  a  simple  apparatus,  devised  by  Von  Bonhorst. 
It  consists  of  two  small  metallic  cups,  attached  to  the  free  ends 
of  a  spring  some  seven  inches  long,  and  which  contain 
sponges  to  hold  the  liquid.     When  used,  the  sponges  in  the 


228  DENTAL  MEDICINE. 


cup  are  saturated  with  the  obtunding  mixture  and  applied  by 
pressing  them  on  the  gum  on  each  side  of  the  tooth  to  be  re- 
moved, where  they  are  retained  from  one-half  to  two  minutes. 
Previous  to  the  application  the  patient  should  be  cautioned 
against  swallowing  any  portion  of  the  mixture.  (See  Cocaine, 
hyperdermic  use  of.) 

Rapid  Breathing  as  a  Pain  Obtimder. — A  method  first  sug- 
gested by  Dr.  W.  G.  A.  Bonwell,  and  from  which  he  claims  a 
similar  effect  to  tliat  of  ether,  chloroform  and  nitrous-oxide 
gas  in  their  primary  stages,  and  to  render  the  patient  suffi- 
ciently unconscious  to  any  acute  pain  from  any  operation, 
where  the  time  consumed  is  not  over  from  twenty  to  thirty 
seconds.  "  While  the  special  senses  are  in  partial  action,  the 
sense  of  pain  is  obliterated  and,  in  many  cases,  completely 
annulled,  consciousness  and  general  sensibility  being  pre- 
served." "  To  accomplish  this,  each  patient  must  be  instructed 
how  to  act  and  what  to  expect.  As  simple  as  it  may  seem, 
there  is  a  proper  and  consistent  plan  to  enable  you  to  reach 
full  success.  Before  the  patient  commences  to  inhale  he  is 
informed  af  the  fact  that  while  he  will  be  unconscious  of  pain, 
he  will  know  full  or  partially  well  any  touch  upon  his  person ; 
that  the  inhalation  must  be  vigorously  kept  up  during  the 
whole  operation,  without  for  an  instant  stopping ;  that  the 
more  energetically  and  steadily  he  breathes,  the  more  perfect 
the  effect.  It  is  obligatory  to  do  so,  on  account  of  its  evanes- 
cent effects,  which  demand  that  the  patient  be  pushed  by  the 
operator  over  energetic  appeals  to  '  go  on.'  It  is  very  difficult 
for  any  one  to  respire  over  one  hundred  times  to  the  minute, 
as  he  will  become  by  that  time  so  exhausted  as  not  to  be  able 
to  breathe  at  all.  For  the  next  minute  following  the  comple- 
tion of  the  operation,  the  subject  will  not  breathe  more  than 
once  or  twice.  Very  few  have  force  enough  left  to  raise  hand 
or  foot.  The  voluntary  muscles  have  nearly  all  been  subju- 
gated and  overcome  by  the  undue  effort  at  forced  inhalation 
of  one  hundred  and  seventeen,  the  normal  standard. 

"  The  heart's  action  is  not  increased  more  than  from  seventy 
(the  average)  to  eighty  and  sometimes  ninety,  but  is  much 


LOCAL  ANESTHESIA.  229 


enfeebled,  or  throwing  a  lesser  quantity  of  blood.  The  face 
becomes  suffused,  as  in  blowing  a  fire  or  in  stooping,  which 
continues  until  the  breathing  is  suspended,  when  the  face 
becomes  paler.  (Have  not  noticed  any  purple,  as  from  as- 
phyxia by  a  deprivation  of  oxygen.)  The  vision  becomes 
darkened,  and  a  giddiness  soon  appears.  The  voluntary  mus- 
cles farthest  from  the  heart  seem  first  to  be  affected,  and  the 
feet  and  hands,  particularly  the  latter,  have  a  numbness  at  their 
extremities,  which  increases  until,  in  many  cases,  there  is  par- 
tial paralysis  as  far  as  the  elbow,  while  the  limbs  become  fixed. 
The  hands  are  so  thoroughly  affected,  that  when  open  the 
patient  is  powerless  to  close  them  and  vice  versa.  There  is  a 
vacant  gaze  from  the  eyes,  and  a  looking  into  space  without 
blinking  of  the  eyelids  for  a  minute  or  more.  The  head  seems 
incapable  of  being  held  erect,  and  there  is  no  movement  of  the 
arms  or  legs,  as  is  usual  when  in  great  pain.  There  is  no  dis- 
position on  the  part  of  the  patient  to  take  hold  of  the  operator's 
hand  or  interfere  with  the  operation,"  Dr.  Bonwell  bases  his 
method  on  the  following  theory: — 

1.  Diversion  of  the  will-force  in  the  act  of  forced  respiration 
at  a  moment  when  the  heart  and  lungs  have  been  in  normal 
reciprocal  action  (twenty  respirations  to  eighty  pulsations); 
which  act  could  not  be  made  and  carried  up  to  one  hundred 
respirations  per  minute  without  such  concentrated  effort  that 
ordinary  pain  could  make  no  impression  upon  the  brain  while 
this  abstraction  was  kept  up. 

2.  There  is  a  specific  effect  resulting  from  enforced  respira- 
tion of  one  hundred  to  the  minute,  due  to  the  excess  of  carbonic 
acid  gas  set  free  from  the  tissues,  generated  by  this  enforced 
normal  act  of  throwing  into  the  lungs yf-z/^  times  the  normal 
amount  of  oxygen  demanded  in  one  minute,  when  the  heart 
has  not  been  aroused  to  exalted  action,  which  comes  from 
violent  action  in  running,  or  where  one  is  suddenly  startled; 
which  excess  of  carbonic  acid  cannot  escape  in  the  same  ratio 
from  the  lungs,  since  the  heart  does  not  respond  to  the  pro- 
portionate overaction  of  the  lungs. 

3.  "Hyperaemia  is  the  last  in  the  chain  of  effects;  which  is 


230  DENTAL   MEDICINE. 


due  to  the  excessive  amount  of  air  passing  into  the  lungs,  pre- 
venting but  little  more  than  the  normal  quantity  of  blood  from 
passing  from  the  heart  into  the  arterial  circulation,  but  damming 
it  up  in  the  brain,  as  well  as  throughout  the  capillary  and  ve- 
nous systems  as  well  as  upon  the  heart,  the  same  as  if  it  were 
suspended  in  that  gas  outside  the  body." 

Dr.  A.  Hewson  agrees  with  Dr.  Bonwell  as  to  the  efficacy 
of  rapid  breathing  as  a  pain  obtunder,  yet  he  differs  with  him 
as  to  the  theory  or  nature  of  the  changes  in  the  different 
symptoms  brought  about  during  its  progress.  Says  Dr.  Hew- 
son :  "  Every  circumstance  would  therefore  seem  to  indicate 
that  this  process  of  inducing  insensibility  to  pain  is  one  essen- 
tially of  diminished  oxidation  and  decarbonization  of  the 
blood,  and  recognizing  such  a  state  as  belonging  to  the  initia- 
tive stage  of  all  anaesthetics,  when  insensibility  to  pain  is 
positively  marked,  we  have  no  necessity  for  begging  any  spe- 
cial theory  for  this  process,  as  in  its  action  it  readily  comes 
under  the  category  of  such  agents,  and  is  thus  not  either  an 
absurdity  or  an  impossibility  from  a  scientific  point  of  view." 

ALCOHOL. 

Formula. — CgHjHO.  Sp.  Gr.  of  officinal  alcohol,  0.820; 
of  rectified  spirit — Spiritus  Rectificatus,  0.838 ;  of  stronger 
alcohol, — Alcohol  Fortius,  0.817;  of  diluted  alcohol — Alcohol 
Dilutum  (equal  parts  of  alcohol  and  distilled  water),  0.928. 

Derivation. — Alcohol  is  obtained  from  vinous  or  fermented 
liquors  by  repeated  distillations,  and,  in  its  officinal  form,  con- 
tains about  fifteen  per  cent,  of  water.  It  is  colorless,  inflam- 
mable, wholly  vaporizable  by  heat,  and  unites  in  all  propor- 
tions with  water  and  ether.  It  frequently  contains  such  im- 
purities as  fusel  oil  or  amylic  alcohol  (obtained  from  fermented 
grain  or  potatoes),  the  presence  of  which  can  be  detected  by 
agitating  the  alcohol  with  sulphuric  acid,  when  the  former 
becomes  colored. 

Stronger  Alcohol. — Alcohol  Fortius — Absolute  Alcohol — is 
obtained  by  agitating  the  officinal  alcohol  with  heated  carbonate 
of  potassium.     Sp.  Gr.  0.794,  when  containing  no  water. 


ALCOHOL.  231 

Medical  Properties  and  Action. — All  the  different  forms  of 
alcohol,  including  brandy — Spiritns  Vini  Gallici  (the  spirit  ob- 
tained from  fermented  grapes  by  distillation,  and  containing 
45  to  55  per  cent,  by  volume,  of  absolute  alcohol);  whiskey — 
Spiritns  Frumenti  (the  spirit  obtained  from  fermented  grain  by 
distillation,  and  containing  from  50  to  58  per  cent,  by  volume, 
of  absolute  alcohol);  wine — Vinum  (the  fermented  juice  of  the 
grape,  and  containing  alcohol  in  varying  proportions),  are 
powerful  diffusible  stimulants,  increasing  the  action  of  the 
heart  and  arteries,  exciting  the  nervous  and  vascular  systems, 
and  causing  a  general  exhilaration  of  spirits.  Excessive  quan- 
tities produce  the  effect  of  narcotic  poisons,  ending  in  coma 
and  death. 

The  habitual  use  of  alcoholic  drinks  causes  most  injurious 
effects  upon  the  system  generally,  and  directly  upon  the  mucous 
coats  of  the  stomach,  deranging  and  destroying  its  functions 
and  structure,  resulting  in  dyspepsia,  followed  by  cirrhosis  of 
the  liver  and  kidneys,  loss  of  mental  and  physical  strength, 
derangement  of  the  nervous  system,  and,  at  last,  delirium 
tremens.  When  properly  administered  in  diseased  conditions, 
however,  alcoholic  preparations  are  valuable  agents. 

Therapeutic  Uses. — The  different  forms  of  alcohol  are  em- 
ployed as  stimulants  in  acute  inflammations,  such  as  pneumo- 
nia, pleurisy,  bronchitis,  pulmonary  affections  of  children,  etc., 
etc.,  and  in  rheumatic  pericarditis,  in  the  latter  stages  of  typhus 
and  typhoid  fevers,  diphtheria,  acute  neuralgia,  convulsions  of 
dentition,  tetanus,  asphyxia  from  cold,  pyaemia,  etc.,  etc.  Ex- 
ternally in  superficial  inflammation,  bruises,  sprains,  ptyalism, 
gout,  cerebral  affections,  bed-sores,  etc.,  etc.  According  to 
Bartholow,  alcohol  is  an  excellent  haemostatic  for  restraining 
oozing  from  a  large  surface,  and  an  efficient  antiseptic  dressing, 
as  it  destroys  germs,  removes  fetor,  and  stimulates  the  tissues 
to  more  healthy  growth. 

Dental  Uses. — Alcohol,  as  a  narcotic,  is  employed  to  relieve 
pain.  In  combination  with  tannic  acid  or  chloride  of  zinc,  it 
obtunds  the  sensibility  of  dentine ;  as  a  styptic,  it  arrests  hem- 
orrhage  from   relaxed   tissues,  coagulating  the  blood  by  its 


232  DENTAL   MEDICINE. 


effect  on  albumen,  and  causing  contraction  of  the  mouths  of 
the  vessels  by  its  astringent  property.  Equal  parts  of  alcohol 
and  water  make  an  excellent  application  as  an  evaporating 
lotion,  for  the  relief  of  superficial  inflammations,  its  antiseptic 
properties  rendering  it  useful  as  a  mouth-wash  when  the  secre- 
tions are  vitiated  and  the  surfaces  of  the  mucous  membrane 
soft  and  spongy.  It  is  also  useful  for  cleaning  pulp-canals  as 
a  preparatory  treatment  to  the  use  of  the  more  active  antisep- 
tic agents,  such  as  the  bichloride  of  mercury.  For  suppurating 
wounds,  it  is  a  useful  antiseptic  dressing,  as  it  destroys  germs, 
removes  fetor,  and  stimulates  the  tissues  to  a  more  healthy 
action.  It  also  favors  the  cicatrization  of  open  wounds,  coag- 
ulating the  albumen,  and  forming  an  impermeable  covering^ 
In  mercurial  salivation  (mercurial  stomatitis),  it  forms  an  ex- 
cellent gargle. 

For  softened  and  sensitive  dentine,  and  for  drying  cavities 
preparatory  to  filling  them,  the  stronger  or  absolute  alcohol  is 
employed.  A  simple  method  of  preparing  this  form  of  alcohol 
is  to  add  one  part  of  carbonate  of  potassa  to  four  parts  of  the 
ordinary  or  officinal  alcohol.  Owing  to  the  great  affinity  car- 
bonate of  potassa  has  for  water,  it  abstracts  the  latter  from  the 
alcohol  to  a  sufficient  degree  to  answer  all  practical  purposes. 

The  cavity  of  a  tooth  is  first  dried  with  cotton  and  bibulous 
paper,  and  then  bathed  with  the  absolute  alcohol,  which  at 
once  evaporates,  and  causes  the  almost  perfect  absorption  of 
moisture. 

Brandy  and  water  form,  in  combination,  an  excellent  lotion 
for  mercurial  and  other  forms  of  stomatitis. 

DENTAL   FORMULA. 

For  Obtunding  Sensitive  Dentine.                   For  Obtunding  Sensitive  Dentine. 
R.     Alcohol  (absolute)     .  ^ss                     R.     Alcohol  (absolute)     .   gss 
Acidi  tannic! .    .    .    .   3  ss                              Zinci  chloridi     .    .    .  3  ss 
Glycerini ^ss.         M.  Glycerini ^ss.         M. 

For  Superficial  Inflammations.  For  Mercurial  Stomatitis. 

R .     Alcohol,  U .     Spts.  vini  gallici    .    .  i  part 

Aquae      .    .    .  aa  .    .  ^  ss.  M.  Aqn9e     ....    4  to  6  parts.    M. 

SiGNA. — To  be  applied  as  a  lotion.  SiGNA. — To  be  used  as  a  gargle. 


ALOES.  233 

Antiseptic  Mouth  Wash.  Gum  camphor    .    .    .   §ss 

Gallipe  and  Malassez.  Tinct.  opium  .    .    .    .  ^j 

R.     Alcohol 370  parts;  Oil  cloves ^ss. 

Carbolic  acid     .    .     10  parts;  Apply  in  the  cavity  on  a  pledget  of  cotton. 

ThjTnol 5  parts ;  For  Odontalgia. 

Oil  of  peppermint  .    15  parts;  Dr.  J.  N.  Harris. 

Tincture  of  arnica.  100  parts.    M.  ^      Alcoholis  (best)     .    .  gj 
This  may  be  colored  with  tmcture  of  Chloroformi    .    .    .    .   .^ij 

^°^^i°^^l-  Etheris  Sulph.    .    .    .  ^  ^ 

SlGNA.-Use  twice  a  day  and  at  same  Camphone  (gum)  .    .  ^ss 

time  rinse  out  the  mouth  with  a  weak  Tinct  ooii  5  '/ 

solution  of  boric  acid.  qj^^^  caryophilli ".   ".  3  ss         M. 

For  Pain  After  Extraction  of  Teeth.  SiGNA.— Apply  to  cavity,  and  soon  as 

pain  ceases,  fill  the  cavity  with  cotton 
Dr.  T.  B.  Welch.  *^    .  ^       ,      .^,        u  r        -^      ^     1 

moistened  with  carbolic  acid  and  oil 

R.     Alcohol  (best)    .    .    .  ^j  of  cloves;  drop  on  this  cotton  sand- 

Chloroform     .    .    .    .  ^  ij  arach  varnish,  and  allow  it  to  remain 

Sulphuric  ether  •    •    •   "a^i  20  or  30  minutes. 

ALOE— ALOES. 

Source. — Aloes  is  the  inspissated  juice  of  the  leaves  of  the 
Aloe  Socotrina,  and  contains  a  bitter  precipitate  known  as  aloin, 
and  also  a  volatile  oil,  to  which  its  odor  is  due.  Its  prepara- 
tions are  purified  aloes — aloe  ptirificata ;  watery  Extract  of 
Aloes — Extractmn  Aloes  Aqiiosttm  ;  Tincture  of  Aloes — Tinc- 
tura  Aloes ;  also  a  number  of  pilular  forms,  and  a  tincture 
combined  with  myrrh — Tinctura  Aloes  et  Myrrhae,  and  wine 
of  aloes — Vinum  Aloes.  Purified  Aloes  is  in  the  form  of 
pieces  of  a  dull  or  reddish-brown  color,  very  brittle  and  soluble 
in  alcohol,  and  a  very  bitter  and  disagreeable  taste. 

Medical  Properties  a?id  Action. — Aloes  is  a  stomachic  tonic 
and  purgative,  being  principally  employed  for  the  latter  effect. 
In  large  doses  its  action  is  that  of  a  powerful  purgative,  and 
hence  it  is  contraindicated  in  irritable  or  inflammatory  condi- 
tions of  the  stomach.  It  stimulates  the  functions  of  the  liver, 
and  increases  the  flow  of  bile  as  well  as  the  intestinal  secre- 
tions generally.  Its  chief  effects  are  on  the  large  intestine, 
increasing  its  peristaltic  movement,  and  causing  tormina  and 
tenesmus  with  heat  and  irritation  of  the  rectum.  It  also  in- 
creases the  menstrual  flow  and  the  blood  supply  of  the  pelvic 


234  DENTAL   MEDICINE. 


organs.  It  requires  some  ten  or  twelve  hours  to  produce  its 
cathartic  effects.  A  purgative  action  may  be  induced  by  ap- 
plying it  to  an  exposed  surface.  In  moderate  laxative  doses 
the  stools  are  not  liquid  and  but  slightly  altered  in  character. 
It  is  commonly  administered  in  small  doses  in  combination 
with  nux  vomica. 

Therapeutic  Uses. — Aloes  is  very  efficient  in  constipation 
dependent  on  weakness  of  the  muscular  layer  of  the  large 
intestine.  It  is  also  employed  in  jaundice,  atonic  dyspepsia, 
hemorrhoids  without  active  pelvic  congestion,  amenorrhoea 
dependent  upon  anaemia,  menorrhagia  in  debilitated  conditions, 
gonorrhoea,  catarrh  of  uterus,  etc. 

Dose. — Of  Aloe  purificata,  grj  to  v ;  extractum  aloes  aqiiosum, 
gr.  ss  to  iij ;  Tinctura  Aloes,  f5ss  to  ij ;  Tinctura  Aloes  Myrrhae, 
5ss  to  5ij ;  Vinum  Aloes,  5j  to  oss. 

ALUMEN— ALUM. 

Formula.— Mi^YL^^l^O^  1 2H2O. 

Source. — It  is  found  native  in  Italy,  in  the  neighborhood  of 
volcanoes,  and  is  the  mineral  from  which  the  metal  aluminium 
is  obtained. 

Derivation. — Alum  is  also  obtained  from  aluminous  slate, 
shale  or  schist,  from  which  it  is  obtained  by  the  process  of 
roasting  and  exposure  to  the  air. 

Alum  is  a  white,  slightly  efflorescent  salt,  which  crystallizes 
in  regular  octahedrons.  It  possesses  an  astringent,  acid,  and 
sweetish  taste.  It  is  insoluble  in  alcohol,  but  dissolves  in  from 
fourteen  to  fifteen  times  its  weight  in  cold,  and  three-fourths 
of  its  weight  of  boiling  water. 

Medical  Properties  and  Action. — Alum  is  astringent  and 
styptic,  and  is  employed  both  externally  and  internally.  When 
taken  internally,  it  is  absorbed  into  the  system,  and  has  been 
detected  in  the  liver,  spleen  and  urine.  Excessive  doses  cause 
vomiting,  griping,  purging,  and  inflammation  of  the  gastro- 
enteric mucous  membrane.  Powdered  alum,  in  doses  of  a 
teaspoonful,  is  an  efficient  emetic.  It  coagulates  albumen,  and 
causes  an  abundant  flow  of  saliva,  coagulating  the  albumen 


ALUM.  235 

of  the  saliva  and  buccal  mucus  in  whitish,  membranous 
flakes. 

Its  astringent  influence  is  chiefly  upon  mucous  surfaces. 
Applied  locally  to  relaxed  or  bleeding  parts,  it  corrugates  the 
surrounding  tissues  and  causes  contraction  of  the  capillaries, 
and,  in  this  manner,  acts  as  an  astringent. 

Therapeutic  Uses. — Alum  is  internally  administered  in  diar- 
rhoea, chronic  dysentery,  colica  pictonum,  catarrh  of  the  stom- 
ach, etc.  Externally  it  is  applied  in  ulcerated  and  relaxed 
throat  affections,  ptyalism,  gonorrhoea  and  gleet,  uterine  hem- 
orrhage, morbid  growths,  haematuria,  ophthalmia,  chronic 
whooping  cough,  chronic  skin  diseases,  chilblains,  ulcers, 
hospital  gangrene,  etc.,  etc. 

Dose. — Of  alum,  gr.  x  to  3j  or  3ij,  in  powder,  or  solution 
in  water,  or  in  some  simple  infusion. 

Ammonia  Alum — Sulphate  of  alumina  and  ammonia — 
Alimiince  et  AmmonicB  Sulphas — is  prepared  by  adding  sulphate 
of  ammonia  to  a  solution  of  sulphate  of  alumina. 

Dried  Alum — Aliimen  Exsiccatum  (alum  deprived  of  its 
water  of  crystallization  by  heat) — is  employed  externally 
as  a  mild  escharotic,  to  destroy  exuberant  granulations, 
etc. 

Dental  Uses. — Alum  is  employed  in  dental  practice  as  a 
styptic  in  alveolar  hemorrhage  ;  as  a  gargle  in  stomatitis, 
ulceration,  and  sponginess  of  the  gums,  morbid  or  fungous 
growth  of  gums,  dental  pulp,  etc.,  superficial  hemorrhage  from 
the  mucous  membrane  of  the  mouth,  ulcers  of  the  mouth, 
cancrum  oris,  odontalgia,  etc.,  etc.  In  congested  conditions  of 
the  mucous  membrane  of  the  mouth  and  throat,  alum  gargles 
afford  great  relief  Powdered  alum  added  to  liquor  sodae 
chlorinatai  (Labarraque's  Solution),  is  an  excellent  bleaching 
application  for  discolored  necrosed  teeth. 

The  habitual  use  of  alum  as  an  ingredient  of  a  dentifrice  is 
injurious  to  the  teeth,  on  account  of  the  sulphuric  acid  it 
contains. 

Potassi  alum — Aliiminii  et  Potassii  Sulphas — the  alum  of 
commerce  (which   has  been  superseded   by  ammonia  alum, 


236  DENTAL   MEDICINE. 


will  render  plaster  casts  hard,  when  they  are  boiled  in  a  strong 
solution  for  jjalf  an  hour. 

DENTAL  FORMULA. 
For  Odontalgia.  '  For  Inflamed   and    Ulcerated    Mucous 

R.       Pulveris  aluminis  .    .   ^ij  Membrane  and  Gums. 

Athens  nitrici  .    .    .  gvij.     M.       R-       Pulveris  aluminis  .    .  gr.  Ixxx 
SiGNA.— To  be  applied  on  a  pellet  of                  Aquae  destillatse    .    .  f|x.      M. 
cotton.                                                           SiGNA. — To  be  applied  as  a  mild,  astrin- 
gent gargle. 
For  Ulceration  of  the  Gums  and  Mucous             pgy  Ulcerated  and  Spongy  Gums. 
Membrane  of  the  Mouth.  j>  _       Aluminis Z  i 


Oj 


3y 

^ij.    M. 


R.       Aluminis ^j  Vini 

Zinci  sulphatis   .    .    .   ^ss  Tinct.  cinchonse 

Sodii  borat gr-iv.  Tinct.  myrrhse  . 

Aquse  rosffi ^viij.  M.  Mel.  rosse  .    .    . 

SiGNA. — To  be  applied  as  a  lotion.  SiGNA. — To  be  used  as  a  gargle. 

For  Inflammation  and  Ulceration  of  the  Mouth  and  Throat. 

R  ■     Infus.  lini §  ^"^ 

Tinct.  kino ^j 

Aluminis ^^^ij.     M. 

SiGNA. — To  be  applied  as  a  gargle. 

ALUMINA  ACETAS— ACETATE  OF  ALUMINA. 

Formula. — AI2O32C4H3O34-4HO. 

Derivation. — The  salt,  Acetate  of  Alumina,  is  obtained  by 
the  direct  combination  of  hydrated  alumina  with  acetic  acid, 
or  by  reaction  between  sulphate  of  alumina  and  acetate  of  lead. 
The  solution,  when  properly  prepared,  is  a  clear  fluid,  of  a 
sharp,  sweetish,  astringent  taste,  and  a  distinct  odor  of  acetic 
acid.  When  it  is  evaporated,  there  is  deposited  light,  fragile, 
glossy  scales,  which  are  perfectly  soluble  in  water,  and  not 
readily  affected  by  the  atmosphere. 

Medical  Properties  and  Action. — It  is  disinfectant  and  anti- 
septic. In  maximum  doses  it  produces  an  unpleasant  sensation 
of  warmth  and  fulness  in  the  stomach,  and,  at  the  same  time, 
vertigo  and  confusion  of  the  senses,  which  may  continue  for 
several  hours. 

Therapeutic  Uses. — Acetate  of  alumina  is  rarely  employed 
internally,  and  only  for  zymotic  and  contagious  diseases.  It 
is  generally  used  externally,  and  is  a  very  effectual  remedy  in 


ALUMINII   SULPHIS.  237 


the  treatment  of  wounds,  preventing  pyaemia  in  suppurating 
wounds  and  ulcers.  It  is  also  applied  in  parasitic  skin  affec- 
tions, as  an  injection  in  gonorrhoea,  and  for  the  destruction  of 
animalculje  in  putrescent  fluids.  As  a  surgical  dressing,  it  is 
used  by  keeping  the  wound  saturated  with  a  solution  of 
moderate  strength,  or  by  irrigation.  A  concentrated  solution 
will  preserve  anatomical  subjects  for  a  considerable  time. 

Dose. — Of  acetate  of  alumina,  gtt.  xx  to  gtt.  60  of  the 
SDlution. 

Detttal  Uses. — Acetate  of  alumina  is  useful  in  dental  practice, 
as  an  antiseptic  and  disinfectant  in  cancrum  oris,  ulcers  of  the 
mouth,  suppurating  wounds  of  mucous  membrane,  pyorrhoea 
alveolaris,  alveolar  abscess,  etc.  A  very  weak  solution  has 
been  employed  as  a  mouth  wash  for  offensive  breath  depending 
on  scrofulous  ulcerations,  aphthae,  caries  of  the  teeth,  or  the 
wearing  of  artificial  teeth. 

SULPHITE   OF  ALUMINIUM— ALUMINII   SULPHIS. 

The  sulphite  of  aluminium  is  a  new  antiseptic,  being  a  sul- 
phurous salt  of  aluminium  ;  that  metal  uniting  with  acids  to 
form  salts  in  the  proportion  of  two  molecular  equivalents  of 
the  base  and  three  of  the  acid.  The  persulphite  may  be  made 
by  adding  sulphurous  acid  to  the  undried  sesquisulphite  to 
solution  and  crystallizing  without  heat ;  or  by  precipitating  the 
persulphite  from  solution  with  alcohol,  filtering  or  decanting, 
washing  the  precipitate  with  alcohol  and  drying  on  bibulous 
paper.  The  sulphurous  salts  of  aluminium  are  the  best  repre- 
sentatives of  its  antiseptic,  therapeutic  properties,  two  being  pro- 
duced— the  sesquisulphite  and  the  persulphite;  the  former  being 
insoluble  in  water,  while  the  sulphite  is  soluble.  Three  hundred 
times  as  much  of  the  sesquisulphite  of  aluminium  can  be  admin- 
istered with  safety  as  of  the  bichloride  of  mercury,  and  while  the 
latter  is  two  and  a  half  times  as  active  as  the  aluminium  salt 
in  equal  quantity,  the  difference  in  dose  permissible  favors  the 
relative  efficiency  of  the  latter ;  and  the  same  relations  exist  in 
the  topical  use  of  these  two  agents.  The  insoluble  sesquisul- 
phite  may  be   made  by  taking  the  theoretical  quantities  of 


238  DENTAL   MEDICINE. 


potassic  alum  and  sulphite  of  sodium  and  mixing  their  solu- 
tions in  water;  the  precipitate  to  be  washed  and  carefully  dried. 
The  proportion  is  ten  parts  of  alum  and  eight  of  sodium  sul- 
phite. These  aluminium  salts  are  applicable  to  almost  every 
conceivable  condition  where  an  antiferment  is  indicated. 

AMMONIUM— AMMONIA. 

Formula. — N  H3. 

Ammonia,  often  called  ammoniacal,  or  ammonia  gas,  is 
colorless  and  readily  soluble  in  water,  and  forms  a  number  of 
volatile  stimulants,  such  as  Aqua  ainmonicE — ammonia  water, 
which  is  the  stronger  water  of  ammonia  diluted  with  two 
parts  of  water;  Aqua  ammonicB  fortior — stronger  water  of 
ammonia,  is  made  by  passing  ammonia  gas  into  water  to  make 
its  specific  gravity,  O.900  at  59°  F, ;  Spiritus  ainmonicz — which 
is  a  ten  per  cent,  solution  of  ammonia  gas  in  alcohol ;  Spiritus 
aniinoni(2  aromaticus,  which  is  an  alcoholic  solution  of  carbon- 
ate of  ammonium,  to  which  are  added  oils  of  lemon,  nutmeg 
and  lavender.  (See  also  muriate  of  ammonia,  sal  ammoniac, 
carbonate  of  ammonium,  solution  of  acetate  of  ammonia,  spirit 
of  mindererus,  chloride  of  ammonium,  and  valerianate  of 
ammonium.) 

Medical  Properties  and  Action. — Ammonia  gas  is  very  al- 
kaline, and  an  irritant  to  mucous  surfaces.  Inhaled,  it  causes 
an  overpowering  sense  of  suffocation  and  spasm  of  the  glottis, 
and  when  prolonged,  violent  inflammation  of  the  air-passages. 
Solution  of  ammonia  when  swallowed  causes  destructive  in- 
flammation of  the  mucous  membrane,  extending  to  the 
stomach.  The  long-continued  use  of  ammonia  interferes 
with  digestion  by  neutralizing  the  gastric  juice,  and  by  in- 
creased waste  of  tissue  causes  pallor,  emaciation  and  feeble- 
ness. In  the  blood  it  injures  the  red  blood  globules,  and  thus 
affects  the  nutrition  of  the  body,  being  largely  converted  into 
urea.   The  preparations  of  ammonia  are  stimulant  expectorants. 

Therapeutic  Uses. — Aqua  ammonia  is  administered  by  in- 
halation in  syncope  and  shock,  and  as  a  counter-irritant ;  for 
which  purpose  ammonia  liniment  is  also  employed.     The  in- 


SOLUTION   OF  ACETATE  OF  AMMONIA.  239 

cautious  inhalation  of  ammonia  may  cause  inflammation  of 
the  fauces  and  glottis,  but  when  cautiously  employed  some- 
times gives  relief  to  acute  catarrh  and  hay  asthma.  The  di- 
luted aqua  ammonia  will  relieve  the  pain  of  stings  of  insects, 
and  the  strong  aqua  ammonia  is  an  antidote,  when  at  once 
applied,  to  the  bite  of  venomous  snakes,  and  of  rabid  animals. 
The  aromatic  spirits  of  ammonia  is  useful  in  acidity  of  stomach, 
gaseous  eructations  and  abdominal  distension  ;  also  in  sick 
headache,  and  migraine;  but  the  bromides  are  more  effective 
in  the  latter  affection.  Ammonia  salts  stimulate  the  liver  and 
increase  the  secretions  of  the  kidneys  and  intestinal  mucous 
glands  and  the  action  of  the  heart,  hence  are  frequently  used  in 
adynamic  states,  constipation,  coated  tongue  and  scanty  urine. 
The  preparations  of  ammonia  for  internal  use  correct  obsti- 
nate vomiting  when  the  irritating  substances  are  removed,  and 
the  raatters  vomited  are  acid. 

Dose. — Of  Aqua  Ammonise,  Ttlv  to  5ss,  much  diluted;  of 
Spiritus  Ammonise,  TTtx  to  f5j,  greatly  diluted;  of  Spiritus 
Ammonise  Aromaticus,  f5ss  to  foij. 

Dental  Uses. — Ammonia  is  used  as  a  stimulant  in  danger- 
ous narcosis ;  to  prevent  syncope  or  severe  shock ;  in  facial 
neuralgia,  especially  the  chloride,  and  in  periodontitis  when  it 
is  combined  with  aconite  and  opium.  Aqua  ammonia  is 
locally  applied  as  a  counter-irritant  to  the  gums  in  acute  in- 
flammation of  the  peridental  membrane.  (See  Acetate,  Car- 
bonate, Valerianate  and  Chloride  of  Ammonium). 

LIQUOR    AMMONII    ACETATIS— SOLUTION    OF    ACETATE    OF 
AMMONIA. 

SPIRIT    OF    MINDERERUS. 

Formula. — NH^C2H302. 

Derivation. — Spirit  of  Mindererus  is  obtained  by  saturating 
diluted  acetic  acid  with  carbonate  of  ammonia,  being  a  solu- 
tion of  the  acetate  of  ammonia. 

It  is  a  colorless  liquid,  with  a  saline  taste,  and  requires  to 
be  freshly  made  when  about  to  be  used. 

Medical  Properties  and  Action. — It  is  refrigerant,  diaphoretic, 


240  DENTAL   MEDICINE. 


and  diuretic,  and  its  action  can  be  greatly  increased  by  com- 
bination with  other  remedies.  Few  medicines  are  in  more 
general  use. 

Therapeutic  Uses. — Spirit  of  mindererus  is  employed  in  the 
treatment  of  febrile  and  inflammatory  affections,  and  exanthe- 
mata, sick  headache,  catarrh  and  influenza,  etc.,  etc.  Externally 
it  is  used  as  a  lotion  to  sprains,  bruises,  glandular  enlarge- 
ments, etc. 

Dose. — Of  spirit  of  mindererus,  f5j  to  fSj. 

Dental  Uses. — A  lotion  composed  of  one  part  to  ten  of 
water  is  a  serviceable  application  in  inflamed  conditions  of 
mucous  membrane.  Internally  administered  as  a  refrigerant, 
it  is  useful  in  acute  periosteal  inflammation,  inflammation  of 
the  dental  pulp — pulpitis,  and  is  a  diaphoretic  and  refrigerant 
in  periodontitis,  when  it  may  be  combined  with  either  aconite 
or  opium,  or  both. 

AMMONII  CARBONAS— CARBONATE  OF  AMMONIUM. 

Formula. — N^H^gCgOg. 

Derivation. — Carbonate  of  Ammonium  is  a  sesquicarbonate, 
and  is  obtained  by  subliming  a  mixture  of  chloride  of  ammo- 
nium and  chalk.  It  is  in  the  form  of  white,  translucent 
masses,  with  a  pungent,  ammoniacal  odor,  and  an  acrid, 
alkaline  taste.  It  is  soluble  in  water,  and  on  exposure  to 
the  air  it  becomes  opaque  and  falls  into  powder,  losing  its 
ammonia. 

Medical  Properties  and  Action. — It  is  antacid,  stimulant,  dia- 
phoretic and  expectorant,  and  it  is  considered  to  be  especially 
useful  in  cases  where  the  vital  powers  are  greatly  depressed. 
In  large  doses  it  causes  colic,  convulsions  and  great  dis- 
turbance of  the  nervous  system,  and  when  long  continued, 
an  annoying  itching  of  the  scalp,  and  skin  over  the  surface 
of  the  body.  It  has  a  tendency  to  fluidify  the  blood.  Inter- 
nally, as  a  diffusible  stimulant,  it  is  preferred' to  solution  of 
ammonia. 

Therapeutic  Uses. — It  is  internally  administered  in  diabetes, 
scrofula  with  languid  circulation,  asthma,  pneumonia,  croup, 


CHLORIDE   OF  AMMONIUM.  241 

chorea,  diseases  of  the  skin,  puerperal  insanity,  mercurial 
erethism,  drunkenness,  etc.,  etc. 

Externally  it  is  employed  as  a  volatile  or  smelling  salts,  in 
syncope,  hysteria,  and  asphyxia. 

Dose. — Of  carbonate  of  ammonium,  gr.  v.  to  gr.  x,  in  pill  or 
in  solution  with  gum  and  sugar. 

Dental  Uses. — It  is  a  useful  internal  remedy  in  cancrum  oris, 
in  doses  of  gr.  v,  gradually  increased  to  gr.  x,  every  two  or 
three  hours,  using  strong  nitric  acid  as  a  local  application.  It 
is  also  a  very  useful  remedy  in  mercurial  erethism,  in  conjunc- 
tion with  camphor  and  other  stimulants ;  also  as  a  stimulant 
in  dangerous  narcosis  from  anaesthetic  agents. 

AMMONII  VALERIANAS— VALERIANATE  OF  AMMONIUM. 

Formula. — NH^CsHjOg. 

Derivation. — Valerianate  of  ammonium  is  obtained  by  com- 
bining valerianic  acid  with  a  strong  solution  of  ammonia  and 
evaporating  to  a  syrupy  consistence  ;  it  is  also  obtained  by  sub- 
jecting the  monohydrated  acid  to  the  action  of  dry,  gaseous 
ammonia.  It  is  in  the  form  of  a  white  salt,  in  quadrangular 
plates,  with  the  odor  of  valerianic  acid,  and  a  sharp,  sweetish 
taste.     It  is  soluble  in  water  and  alcohol. 

Medical  Properties  and  Action. — It  is  stimulant,  nervine,  and 
antispasmodic. 

Therapeutic  Uses. — It  is  employed  in  neuralgia,  nervous  head- 
ache, hysteria,  epilepsy,  chorea,  etc.,  etc.,  especially  for  females. 

Dose. — Of  valerianate  of  ammonium,  gr.  ij.  to  gr.  viij,in  pill 
or  elixir,  with  aromatics  (valerianate  of  ammonium  5j,  fluid 
extract  of  vanilla  f^ss,  tincture  of  cardamom  fSvj,  curacoa 
f5ij,  water  f^iv — Misce.  Dose,  a  teaspoonful  three  times  a 
day). 

Dental  Uses. — It  is  internally  administered  for  neuralgia. 

AMMONII   CHLORIDUM— CHLORIDE   OF   AMMONIUM. 

MURIATE    OF    AMMONIA — HYDROCHLORATE   OF    AMMONIA — SAL 

AMMONIAC. 

Formula. — NH^Cl. 

Derivation. — Chloride  of  Ammonium  is  obtained  by  neu- 
i6 


242  DENTAL  MEDICINE. 


tralizing  hydrochloric  acid  with  ammonia,  and  evaporating  to 
dryness.  It  is  in  the  form  of  a  snow-white,  crystaUine  powder, 
soluble  in  two  and  a  half  parts  of  cold  water,  and  sparingly 
soluble  in  alcohol.     It  has  a  pungent,  saline  taste. 

Medical  Properties  and  Action. — In  large  doses  it  is  an  irritant 
poison,  with  a  purging  action  ;  but  in  small  doses  it  is  a  power- 
ful resolvent  alterative  ;  it  is  also  refrigerant  and  anodyne.  Its 
action  upon  the  system  closely  resembles  that  of  mercury  as 
an  alterative. 

Externally  it  is  used  as  a  discutient  application,  and  as  a 
cold  lotion  in  fevers,  hernia,  etc. 

Therapeutic  Uses. — It  is  employed  internally  in  amenorrhoea, 
rheumatic  affections,  chronic  bronchitis,  pneumonia,  dropsical 
affections,  hemorrhages,  whooping  cough  and  myalgia.  Ex- 
ternally in  abscesses  of  the  mamma,  skin  diseases,  ecchy- 
mosis  of  the  eye,  hydrocele,  senile  gangrene,  gonorrhoea, 
leucorrhoea,  etc. 

Dose. — Of  chloride  of  ammonium,  gr.  v-xxx,  every  two  or 
three  hours,  in  powder  or  mucilage. 

Dental  Uses. — It  is  employed  in  facial  neuralgia,  in  doses  of 
5ss,  repeated  four  times  daily.  Externally  it  is  used  as  an 
application  to  indolent  ulcers,  for  its  stimulating  effect.  As  a 
gargle,  it  is  employed  in  the  strength  of  5ss  to  §xij  of  water. 
It  is  also  applied  to  cancerous  tumors,  and  has  been  used  to 
restore  zinc  which  has  become  deteriorated  from  long  use  in 
laboratory  work.  Chloride  of  ammonium  (sal  ammoniac)  is 
also  used  as  a  flux,  in  refining  gold  for  laboratory  use. 

AMYLENE. 

Formula  CgH^,,. 

Derivation. — Amylene  is  obtained  by  distilling  amylic  alcohol 
with  chloride  of  zinc.  It  is  a  colorless,  very  mobile  liquid, 
with  a  boiling  point  of  102°,  and  the  density  of  its  vapor  2.45. 
It  has  a  very  peculiar  and  disagreeable  smell. 

Medical  Properties  and  Action. — Amylene  was  introduced  as 
an  anaesthetic  in  1856,  by  the  late  Dr.  Snow,  who  regarded  it 
as  possessing  the  following  advantages :  the   safety  of  ether, 


AMYLENE.  243 


absence  of  pungency  and  irritating  property,  readiness  with 
which  the  absence  of  pain  is  obtained,  with  less  coma  than 
with  chloroform  or  ether,  the  speedy  recovery  from  its  effects, 
less  nauseating,  and  less  headache  and  rigidity  and  struggling 
than  in  the  case  of  ether  or  chloroform.  Others,  however, 
have  not  been  so  much  impressed  with  this  anjesthetic  agent  as 
was  Dr.  Snow ;  hence,  it  has  not  been  regarded  with  the  same 
favor  as  other  agents  of  this  class.  An  extreme  quantity 
being  required  to  produce  complete  insensibility  to  pain,  its 
operation  is  considered  to  be  dangerous. 

Therapeutic  Use. — As  an  anaesthetic. 

Hydrate  of  Aniylene  is  a  tertiary  alcohol  first  prepared  by 
Wurtz.  It  is  a  colorless,  watery-looking  fluid,  with  a  sharp 
taste  and  smell,  and  is  soluble  in  eight  times  its  volume  of  al- 
cohol. It  is  generally  regarded  as  a  safe  and  reliable  narcotic 
and  hypnotic,  sleep  being  produced  in  from  fifteen  to  forty- 
five  minutes,  and  sometimes  almost  instantly.  Where  large 
doses  are  given,  sleep  may  be  induced  in  five  or  eight  minutes, 
and  as  a  rule  its  actions  are  prompt  and  safe.  Contra-indi- 
cations  of  the  drug  have  not  yet  been  observed,  but  in  cases 
of  severe  gastric  troubles  and  ulcerations  of  the  pharynx, 
it  should  be  given  per  anus.  Its  action  may  be  briefly 
summed  up  as  follows  : 

1.  Hydrate  of  amylene  is  a  hypnotic  whose  action  can  be 
confidently  relied  upon  when  sufficiently  large  doses  are  given. 
Experiments  have  shown  that  it  is  not  so  strong  as  chloral, 
yet  stronger  than  paraldehyde. 

2.  Hydrate  of  amylene  also  acts  upon  persons  who  are  ac- 
customed to  the  use  of  hypnotics,  although  the  dose  employed 
in  such  cases  must  be  comparatively  large. 

3.  Sleep  occurs  soon  after  the  administration  of  the  drug, 
and  is  not  preceded  by  any  period  of  excitement.  The  sleep 
produced  is  light  or  heavy,  according  to  the  dose  given ;  yet 
it  is  always  easy  to  awaken  the  patient.  Upon  waking,  the 
patient  is  perfectly  sensible  and  bright,  but  if  not  disturbed 
further  will  at  once  fall  asleep  again. 

4.  Sleep  lasts   from  two  to  three  hours  if  small  doses  have 


244  DENTAL   MEDICINE. 


been  given,  or  from  six  to  eight  hours  under  the  influence  of 
larger  doses. 

5.  The  awaking  is  similar  to  that  from  natural  sleep.  The 
patient  feels  rested  and  strengthened.  No  headache  or  weak- 
ness was  ever  observed. 

6.  The  respiration  remains  unchanged. 

7.  The  change  in  the  pulse's  frequency  and  in  the  pressure 
of  blood  is  no  more  than  that  which  accompanies  natural  sleep. 

8.  The  patients  were  never  observed  to  wake  up  with  a  bad 
taste  in  their  mouths  and  complaining  of  a  disagreeable  smell, 
symptoms  which  nearly  always  follow  the  use  of  paraldehyde. 

9.  Whether  or  not  a  habit  and  tolerance  for  the  drug  may 
be  formed  remains  yet  to  be  seen.  As  yet,  even  when  the  dose 
has  been  used  continually,  an  increase  of  dose  was  never  found 
necessary. 

Dose. — Of  hydrate  of  amylene  grs.  xii  to  grs.  xxxvii.  It 
m.ay  be  administered  in  gelatin  capsules  containing  15^  grains 
each,  or  in  the  fluid  form  mixed  with  claret  and  water,  or 
raspberry  syrup. 

AMYL  NITRIS— NITRITE  OF  AMYL. 

Formula. — CgHi^NOg.     Sp.  gr.  0.877. 

Derivation. — Nitrite  of  Amyl  is  obtained  by  heating  one 
part  of  strong  nitric  acid  with  two  parts  of  rectified  fusel  oil, 
until  reaction  commences,  when  the  heat  is  withdrawn,  and 
afterward  re-applied.  The  distilled  portion  obtained  below 
212°  F.  is  rectified  by  means  of  carbonate  of  potassium,  and 
that  portion  only  distilling  between  200°  and  206°  F.  is  re- 
served, being  a  nitrate  of  the  oxide  of  amyl.  It  is  a  yellowish 
or  amber-colored  liquid,  somewhat  oily,  very  volatile  and  in- 
flammable, and  boils  at  182°  F.  It  has  an  odor  like  that  of 
ripe  pears,  and  belongs  to  the  class  of  compound  ethers. 

Medical  Properties  and  Action. — It  is  used  by  inhalation, 
causing  an  accelerated  action  of  the  heart,  sudden  flushing  of 
the  face,  dilatation  of  the  arteries,  paralysis  of  the  action  of 
the  smaller  arteries,  a  sense  of  great  fullness  of  the  brain,  a 
lowering  of  the  blood  pressure  and   temperature,  and  com- 


NITRITE  OF  AMYL.  245 


plete  resolution  of  the  muscular  system.  The  vapor  of  nitrite 
of  amyl,  when  applied  directly  to  the  muscular  or  nervous 
tissues,  arrests  their  functional  activity,  and,  circulating  in  the 
blood,  appears  to  act  most  on  the  vaso-motor  system  and 
unstriped  muscular  fibre.  It  affects  respiration  and  the  com- 
position of  the  blood,  producing  headache,  which  is  often  pro- 
longed. 

Therapeutic  Uses. — Being  a  powerful  stimulant  to  the  heart, 
it  is  an  antidote  to  chloroform  and  cocaine.  A  case  is  men- 
tioned in  the  Bntish  Medical  Journal, w\verQ,d\\rmgc\\\ovo{orvs\ 
narcosis,  respiration  ceased,  and  artificial  respiration  failed  to 
restore  the  patient.  Some  nitrite  of  amyl  was  then  poured  on 
lint,  and  held  to  the  patient's  nostrils.  In  ten  seconds  there 
was  a  flushing  of  the  face,  the  pulse  was  again  felt,  and  respi- 
ration was  restored. 

When  from  two  to  five  minims  are  poured  on  lint  and  applied 
to  the  nostrils,  the  heart's  action  will  be  accelerated,  a  sudden 
flushing  of  the  face  takes  place,  dilatation  of  the  arteries  results, 
also  a  fall  in  the  blood  pressure  and  a  lowering  of  the  temper- 
ature, and  complete  muscular  relaxation.  As  a  remedy  for 
chloroform  narcosis,  it  is  supposed  to  antagonize  cerebral 
anaemia  by  causing  capillary  dilatation  and  thus  promoting  the 
inflow  of  blood  to  the  brain. 

By  inhalation,  for  relieving  the  pain  of  angina  pectoris,  and 
preventing  epileptic  seizures;  also  used  in  asthma,  strychnia 
poisoning,  hydrophobia,  tetanus,  epileptic  attacks,  and  in  many 
other  convulsive  or  spasmodic  diseases. 

Dose. — Of  nitrite  of  amyl,  TTLij  to  TTLv,  by  inhalation  ;  not 
more  than  TTL.  iij  should  be  administered,  unless  the  patient 
has  been  accustomed  to  its  use. 

Dental  Uses. — As  an  antidote  for  chloroform  narcosis,  for 
the  relief  of  epileptic  attacks  during  the  extraction  of  teeth, 
for  relieving  the  pain  of  neuralgia  of  the  fifth  pair  of  nerves, 
and  for  restoration  from  syncope.  As  nitrite  of  amyl  is  a 
powerful  and  dangerous  agent,  care  must  be  observed  in  its 
use,  and  but  small  doses  applied  at  first,  as  some  patients, 
especially  the  weak  and  nervous,  are  very  susceptible  to  its 
influence. 


246  DENTAL   MEDICINE. 


ANTHEMIS— CHAMOMILE. 

Source. — The  flowers  of  the  Anthemis  Nobilis.  A  German 
variety  is  known  as  Matricaria,  which  is  similar  to  Anthemis 
in  its  effects.  The  herb  chamomile  has  a  fragrant  odor  and  a 
bitter  aromatic  taste.  A  volatile  acid  is  obtained  from  the 
flowers,  which  is  similar,  if  not  identical,  with  valerianic 
acid. 

Medical  Properties  and  Therapeutic  Uses. — Chamomile  is  a 
mild  tonic  in  small  doses,  but  in  large  doses  may  act  as  an 
emetic.  It  is  used  in  the  form  of  a  cold  infusion  in  enfeebled 
digestion,  flatulent  colic  and  infantile  disorders  connected 
with  digestive  derangement.  It  is  also  employed  in  the  form 
of  infusions  prepared  with  hot  water  and  vinegar,  for  the  re- 
lief of  pain  of  boils,  abscesses,  etc.  When  employed  for  the 
relief  of  odontalgia  in  the  form  of  fomentations  to  the  face, 
there  is  danger  of  the  abscess  pointing  externally;  it  is  also 
applied  to  flabby,  ill-conditioned  ulcers  as  a  gentle  incitant. 
The  tepid  infusion  will  promote  the  operation  of  emetics. 

Dose. — Of  the  powder  as  a  tonic,  5ss  to  5j.  It  is  generally 
employed  in  the  form  of  infusion. 

ANILINE. 

Formula. — CgHyN. 

Derivation. — Aniline  is  an  alkaloid  obtained  by  the  destruc- 
tive distillation  of  various  organic  substances.  It  is  a  volatile, 
colorless,  pungent  liquid  generally  derived  from  coal  tar. 

Medical  Properties  and  Therapeutic  Uses  — Professor  Stilling 
claims  that  wounds  and  suppurating  ulcers,  especially  those 
in  and  about  the  eye,  treated  with  aniline  may  be  entirely 
sterilized  by  the  solution  penetrating  everywhere,  and  the 
suppuration  be  entirely  arrested.  When  the  pus  is  deep  in 
the  tissue,  injections  of  aniline  solution  should  be  employed, 
or  the  introduction  of  aniline  crayons,  or  bathing  with  con- 
centrated solutions.  In  many  cases  application  of  a  powdered 
aniline  is  very  efficacious.  These  aniline  colors  are  destitute 
of  all  toxic  action ;  they  are  very  diffusible,  and  they  do  not 
coagulate  albumen.     These  colors  are,  however,  soon  decom- 


ANTIFEBRIN— ACETANILIDE.  247 

posed   by  exposure   to   light,  and  they  should  therefore  be 
protected. 

Dental  Uses. — But  two  of  the  basic  aniline  coloring-matters, 
methyl-violet  {'py6kt^mn)  and  niethyleneblue ,  have  been  tested  as 
antiseptics,  and  although  highly  recommended  by  Prof  Stilling, 
they  have  not,  in  the  experiments  of  Prof  W.  D.  Miller,  when 
employed  as  antiseptics  in  the  treatment  of  the  dental  pulp,  given 
satisfactory  results,  as  they  did  not  appear  to  penetrate  the 
pulps  to  a  depth  of  more  than  a  quarter  of  an  inch,  and  showed 
no  preservative  action.     (See  Pyoktanin.) 

ANTIFEBRIN— ACETANILIDE. 

Formula. — C2H3NO. 

Antifebrin,  as  Acetanilide  is  commonly  called,  is  a  white 
crystalline  powder  composed  of  colorless  scales  or  plates  sim- 
ilar to  boric  acid.  It  is  slightly  soluble  in  water,  but  readily 
soluble  in  alcohol,  and  has  a  burning  but  not  disagreeable 
taste.     Chemically  it  is  aniline. 

Medical  Properties  and  Therapeutic  Uses. — In  regard  to  its 
properties  as  an  antipyretic  opinions  differ,  but  it  is  generally 
regarded  as  being  more  powerful  than  antipyrine.  It  in- 
creases the  intra-vascular  blood  pressure,  and  the  action  of 
the  central  nervous  apparatus,  but  a  quantitative  decline  en- 
sues in  the  functions  of  motility  and  sensibility  until  they  are 
altogether  suspended.  The  quantity  required  to  produce 
antipyretic  effects  varies  from  four  to  eight  grains,  the  latter 
dose  lessening  fever  heat  effectively,  as  it  reduces  the  tempera- 
ture and  pulse-rate.  It  is  employed  in  fevers,  neuritis,  neural- 
gia, myalgia,  locomotor  ataxis,  herpes  zoster,  migraine,  sciatica, 
epilepsy,  etc.  Three  to  five  grain  doses  ter  die  will  relieve 
the  pains  of  inflammations,  such  as  neuralgia,  myalgia, 
migraine,  etc. 

Dental  Uses. — Antefebrin  has  been  employed  successfully 
in  acute  periodontitis,  five  to  eight  grains  causing  a  quiet  sleep 
with  no  return  of  the  pain.  It  is  also  administered  for  pulpi- 
tis, etc. 


248  DENTAL   MEDICINE. 


Dose  of  Antefibrin. — Grs.  v  to  grs.  viij. 

A  Convenient  Prescription  of  Antifebrin. 
Dr.  E.  L.  Clifford, 

R.     Antefibrin  (Acetanilide) 3J 

Sp.  vini  gallici .    .    .  5  iv.  ss 

Syr.  Simp 

Aquse aa  ^vj.     M. 

S.     A  tablespoonfiil  contains  five  grains,  an  adult  dose. 

ANTIKAMNIA. 

Formula. — CnH2n-6. 

Antikamnia  is  a  combination  of  coal  tar  derivatives  into 
which  the  amnines  have  entered,  forming  various  amido  com- 
pounds. It  has  as  its  base  the  derivatives  of  the  amido-benzoles 
so  combined,  it  is  claimed,  as  to  obviate  the  bad  effects  caused 
by  many  of  this  series  of  organic  bodies  when  administered 
alone.  It  is  in  the  form  of  a  white  powder  with  a  pungent 
taste. 

Medical  Properties  and  Therapeutic  Uses. — Antikamnia  is 
an  antipyretic,  analgesic  and  anodyne,  and  causes  a  quieting 
influence  upon  the  nervous  system,  inducing  and  promoting 
sleep.  It  is  employed  in  neuralgia,  myalgia,  sciatica,  acute 
rheumatism,  hemicrania,  typhoid  fever;  also  headache  and 
other  neuroses  due  to  irregularities  of  menstruation ;  also  in 
asthma,  hay  fever,  influenza,  la  grippe  and  allied  affections. 

Dose. — grs.  iij  to  grs.  x,  every  three  or  four  hours. 

To  Prevent  the  Disturbance  of  the  Ner-  Syr.  Aurantii  Flor.  aa    .   ^  iv.    M. 

vous   System  which   accompanies   the  gj^^     Tablespoonful    every    3    or    4 

administration  of  quinine :  , 

R .     Antikamnia 5  ss  Anodyne  and  Analgesic. 

Sulphate  of  quinine  .    .  9ij.    M.       ^      Antikamnia     .... 

Make  xii  capsules,  one  every  2  q^j^j^  ^^^^-^    ^^    ^  ^^^ 

or  4  hours  as  may  be  indicated.  p^j^    j^^^^^  ....  grs  viii 

Analgesic  and  Anodyne.  Soda  bicarb grs.  xij 

R .     Antikamnia 3  ij  Ft.     viij  capsules. 

Spts.  Vin.  Gall  ....  Dose.     One  capsule  every  4  hours. 


ANTIPYRINE.  249 


ANTIPYRINE— DIMETHYLOXYQUINIZINE. 

Formula. — CaoHigN^Oj. 

Antipyrine  is  in  the  form  of  whitish  or  grayish-white  crys- 
talline powder,  slightly  bitter  sweetish  taste,  and  soluble  in 
water.     It  combines  with  acids  to  form  salts. 

Medical  Properties  and  Therapeutic  Uses, — Antipyrine  is  a 
powerful  antipyretic,  local  anaesthetic,  disinfectant,  hemostatic 
and  stomachic  tonic,  and  acts  as  an  antiseptic  in  preventing  fer- 
mentative changes  in  the  intestines.  It  is  also  slightly  hyp- 
notic. It  stimulates  the  secretions  and  readily  diffuses  into 
the  blood.  It  first  stimulates  and  then  paralyzes  the  nerve- 
centres,  dilates  the  cutaneous  vessels,  and  increases  the  loss 
of  heat  by  radiation,  reducing  the  temperature  rapidly.  Some- 
times it  may  cause  dangerous  symptoms,  such  as  a  feeble 
pulse,  profuse  diaphoresis  and  collapse.  It  is  employed  in 
typhoid  and  malarial  fevers,  pneumonia,  phthisis,  neuritis, 
sciatica,  locomotor  ataxis,  neuralgia  of  the  fifth  pair  of  nerves 
associated  with  neuritis  and  sciatica,  migrain,  acute  rheuma- 
tism, epilepsy,  chorea,  etc.,  and  as  a  substitute  for  morphine, 
and  in  the  morphine  habit. 

Its  administration  is  soon  followed  by  profuse  perspiration, 
coldness  of  the  surface,  slowed  pulse,  depression,  and  if  fever 
is  present  by  lowered  temperature  within  a  half  hour  after 
taking  the  drug.  In  health  its  use  may  cause  slight  nausea, 
singing  in  the  ears,  and  a  slight  decrease  in  the  temperature  of 
the  body.  It  has  no  effect  upon  respiration,  but  acts  as  a  seda- 
tive upon  the  brain.  It  is  eliminated  by  the  kidneys,  appear- 
ing in  the  urine  about  three  hours  after  ingestion. 

Dose, — Grs.  v  to  grs.  Ix,  being  determined  by  its  uses.  Sub- 
cutaneously  injected,  it  is  very  effective  in  painful  affections 
originating  in  the  nerves. 

The  hypodermic  use  of  antipyrine  has  given  very  satisfac- 
tory results  in  the  treatment  of  nervous  articular  and  muscular 
pains,  gastric  affections,  bronchial  asthma,  articular  rheuma- 
tism, chronic  lumbago.  A  painless  injection  may  be  made  by 
half-filling  a  hypodermic  syringe  with  a  fifty  per  cent,  solution 


250  DENTAL   MEDICINE. 


of  antipyrine,  which  will  amount  to  about  five  and  a  half 
grains ;  the|i  immerse  the  syringe  into  a  ten  per  cent,  solu- 
tion of  cocaine,  drawing  up  enough  of  the  cocaine  into  the 
syringe  to  make  it  about  three-fourths  full  ;  this  will  amount 
to  one-third  grain  of  cocaine.  The  two  solutions  readily  mix 
and  do  not  decompose,  and  may  be  used  as  a  local  anaesthetic. 
Dental  Uses. — Antipyrine  is  used  hypodermically  with 
great  success  in  cases  of  severe  neuralgia  of  the  fifth  pair  of 
nerves.  Also,  in  cases  of  acute  pericemental  irritation,  and  in 
reflex  neuroses  of  dental  origin  it  has  given  great  relief.  Fif- 
teen grains  in  half  an  ounce  of  water  have  given  relief  in  a 
case  of  pericementitis,  ceasing  in  twenty  minutes  with  no  re- 
turn of  the  pain  :  but  many  prefer  antifebrin  (acetanilide)  as 
being  safer  than  antipyrine.  It  also  has  a  marked  effect  in 
controlling  hemorrhage  from  the  gums  and  alveolar  cavities 
when  used  as  a  haemostatic  after  the  extraction  of  teeth.  Prof 
G.  Cesari  claims  that  antipyrine  more  or  less  speedily  arrests 
hemorrhage  from  both  large  and  small  blood-vessels  when 
applied  in  solutions  of  not  less  than  forty,  or,  better,  fifty  per 
cent.  The  solution  as  well  as  the  powder  should  be  applied 
on  pledgets  of  cotton  wool.  Antipyrine  has  also  been  admin- 
istered internally  with  satisfactory  results  in  the  treatment  of 
periodontitis  ;  and  in  cases  where,  owing  to  the  severity  of  the 
symptoms  in  the  same  affection,  the  internal  administration 
has  proven  unsuccessful,  the  hypodermic  injection  of  fifteen 
grains  has  afforded  relief;  or  the  hypodermic  injection  followed 
in  one  half  hour  by  the  internal  administration  of  fifteen  grains 
of  the  drug  will  afford  relief  in  cases  of  acute  periodontitis. 

For  Nervous  Cases. 
R .     Antipyrine gr.  xviij 

Aq.  destillat q.s.  ad  ft,  sol. 

Ft.  sol  et  adde 

Acidi  valerianici  .    .    .  gtt.  xv. 
Shake  well  and  stand  aside  to  allow  salt  to  crystallize. 

ANTISEPTIC  AND  STYPTIC  COTTON-WOOL. 
Antiseptic  Cotton. — ^First  free  the  ordinary  cotton-wool  from 
grease,  by  macerating  it   in  benzine  for  ten  minutes,  press 
and  dry  in  the  air.     Then  steep  the  purified  cotton,  for  ten 


NITRATE   OF   SILVER.  251 


minutes,  in  a  solution  of  tannin  5,  carbolic  acid  4,  alcohol  50, 
and  castor  oil  8  parts. 

Styptic-Cotton-Wool. — Purify,  as  before,  with  benzine,  dry  in 
air,  and  then  steep  it  in  a  solution  of  alum  2,  water  12,  chlor- 
ide of  iron  solution  2  parts ;  dry  at  60°  C. 

AQUA  DESTILLATA— DISTILLED  WATER. 

Derivation, — "  Take  of  water  80  pints.  Distill  two  pints, 
using  a  tin  or  glass  condenser,  and  throw  them  away ;  then 
distill  64  pints,  and  keep  them  in  glass  bottles." — U.S.D. 

Properties. — Distilled  water  has  a  vapid,  and  by  no  means 
pleasant  taste,  and  is  only  perfectly  pure  when  the  vessel  used 
in  the  distillation  is  of  silver.  It  should  evaporate  without 
residue. 

Therapeutic  Uses. — It  is  very  essential  in  the  preparation  of 
some  formulae,  and  of  no  use  whatever  in  others,  as  the  com- 
mon pure  water  will  answer.  Such  agents  as  tartar  emetic, 
nitrate  of  silver,  corrosive  sublimate,  chlorides  of  calcium, 
barium,  acetate  and  subacetate  of  lead,  permanganate  of 
potassa,  the  sulphates  of  iron  and  zinc,  sulphate  of  quinia,  the 
salts  of  morphia,  and  all  the  alkaloids  and  their  salts,  require, 
when  given  in  solution,  distilled  water. 

Dental  Uses. — Distilled  water  is  required  in  the  preparation 
of  many  formulae  for  use  in  dental  practice. 

ARGENTI  NITRAS— NITRATE  OF  SILVER. 
LUNAR  CAUSTIC. 

Formula. — AgN03. 

Derivation. — Nitrate  of  Silver  is  obtained  by  dissolving 
silver  in  nitric  acid  and  distilled  water,  and  evaporating  the 
solution.  It  is  in  the  form  of  a  heavy,  colorless,  anhydrous 
salt,  and  crystallizes  in  shining,  rhombic  plates.  The  action  of 
light  and  organic  matters  causes  it  to  turn  black.  It  is  wholly 
soluble  in  distilled  water,  the  only  preparation  of  water  that 
should  be  employed  in  forming  solutions  of  this  salt.  It  has 
a  strong,  metallic,  styptic  taste.  In  the  preparation  of  the  solid 
form  of  sticks,  it  is  first  melted  and  poured  into  moulds,  ex- 
posure to  the  light  causing  the  sticks  to  become  gray,  and 


252  DENTAL   MEDICINE. 


more  or  less  dark,  owing  to  the  reduction  of  the  silver  by  the 
sulphuretted  hydrogen  contained  in  the  atmosphere  ;  hence, 
on  account  of  the  decomposition  of  this  salt,  it  should  be  care- 
fully excluded  from  the  light. 

Medical  Properties  and  Action. — Nitrate  of  silver  is  tonic, 
antispasmodic,  sedative  and  astringent.  When  applied  to  the 
skin,  mucous  membrane,  or  ulcers,  it  produces,  at  first,  a  white 
appearance,  owing  to  its  union  with  the  coagulated  albumen  of 
the  cuticle,  but  this  gradually  changes  to  a  bluish-gray,  purple, 
and  finally,  black  color,  on  account  of  the  partial  reduction  of 
the  silver  by  the  sulphuretted  hydrogen.  Small  doses,  ad- 
ministered for  a  long  time,  give  a  peculiar  blue  appearance  to 
the  skin.  When  internally  administered,  it  has  an  astringent 
action  on  the  mucous  coats  of  the  intestines.  It  is  a  power- 
ful tonic  to  the  nervous  system,  and  has  been  chiefly  em- 
ployed as  an  antispasmodic  tonic.  It  is  chiefly  used  ex- 
ternally, as  a  stimulant,  vesicant,  and  escharotic.  If  applied, 
even  lightly,  three  or  four  times,  to  the  moistened  skin,  it  will 
cause  vesication  in  a  few  hours.  The  blue  appearance  on  the 
skin,  when  small  doses  are  long  continued,  is  said  to  be  pre- 
ceded by  a  peculiar  blue  line  on  the  gums,  like  that  from  lead 
poisoning.  A  very  minute  quantity  of  this  salt,  when  inter- 
nally administered,  is  eliminated  by  the  kidneys,  as  most  of  it 
escapes  by  the  liver  and  the  intestinal  glands,  a  portion  re- 
maining permanently  deposited  in  the  tissues,  when  its  use  has 
been  long  continued.  Six  weeks  is  the  length  of  time  it  is 
safe  to  continue  its  internal  use,  and  during  that  time  occa- 
sional purgatives  should  be  given,  to  promote  its  elimination. 
The  persistent  use  of  iodide  of  potassium  and  the  hyposul- 
phite of  soda  will  cause  the  absorption  and  excretion  of  the 
silver  deposits,  in  cases  of  skin  discoloration  from  its  long 
continued  use,  aided  by  baths  of  the  hyposulphites,  and  the 
very  careful  use  of  lotions  containing  cyanide  of  potassium, 
which  possesses  a  solvent  power  over  silver  deposits.  As  long 
as  inflammation  is  present,  it  should  not  be  internally  admin- 
istered, and  during  a  course,  it  should  be  occasionally  inter- 
mitted for  a  few  days,  and  a  purgative  used.     The  gums  and 


NITRATE  OF   SILVER.  253 


fauces  should  be  frequently  examined,  and  if  the  slightest  blue 
discoloration  is  observed,  the  remedy  should  be  discontinued. 
Exposure  to  the  sun  should  be  avoided. 

Therapeutic  Uses. — Nitrate  of  silver  is  internally  employed 
in  dyspepsia,  chronic  gastritis,  chronic  diarrhoea  and  dysentery, 
cholera,  diseases  of  the  eye,  chorea,  epilepsy,  asthma  and 
whooping  cough. 

Externally  in  ophthalmia  and  other  diseases  of  the  eyes, 
cutaneous  diseases,  diphtheria,  erysipelas,  hydrophobia,  en- 
largement of  glands,  diseases  of  the  genito-urinary  organs, 
diseases  of  the  ear,  burns,  ulcers,  hemorrhage,  etc.,  etc. 

Dose. — Of  nitrate  of  silver,  gr.  J,  gradually  increased  to 
gr.  ^2  three  times  a  day,  in  pill  made  of  some  vegetable  pow- 
der, or  in  solution.  The  fused  nitrate  of  silver — Argenti 
Nitras  Fusa — or  solid  form,  is  used  externally. 

Dental  Uses. — For  inflamed  and  ulcerated  conditions  of  the 
mucous  membrane  of  the  mouth,  nitrate  of  silver  is  a  valuable 
application,  in  the  form  of  injections  or  solutions  of  various 
strengths,  from  gr.  ij  to  5ss  of  distilled  water  ;  also  in  diseases 
of  the  antrum  and  fistula,  as  an  injection.  It  is  also  used  as  a 
styptic,  for  the  arrest  of  alveolar  hemorrhage,  but  is  not  so  re- 
liable as  tannic  acid,  gallic  acid,  etc.,  on  account  of  the 
coagulum  or  clot  formed  by  it,  being  soluble  in  an  excess  of 
albumen.  It  is  also  employed  to  obtund  the  sensitiveness  of 
dentine,  especially  where  the  cause  is  mechanical  abrasion ; 
also  in  aphthae,  mercurial  stomatitis,  ulceration  of  the  gums, 
salivary  fistula,  alveolar  abscess.  For  obtunding  sensitive 
dentine,  the  stick  form  (one  end  of  a  stick  inserted  into  a 
quill,  or  fused  on  the  end  of  a  platinum  wire)  is  employed ;  or 
the  end  of  a  silver  wire  may  be  immersed  in  nitric  acid,  and 
applied  to  the  sensitive  surface,  taking  care  to  limit  its  action 
to  the  part  on  which  it  is  to  act.  When  applied  to  sensitive 
dentine,  it  acts  on  the  gelatinous  portion  of  the  tooth,  destroy- 
ing its  vitality  to  the  extent  of  the  combination  which  takes 
place.  The  objection  to  its  use  in  such  cases  is  the  discolora- 
tion it  causes. 

As  salt  decomposes  the  nitrate  of  silver,  a  solution  of  the 


254  DENTAL   MEDICINE. 


chloride  of  sodium  will  relieve  the  excessive  pain  following 
its  applicatioq  to  sensitive  dentine,  or  to  ulcers  of  the  mouth ; 
such  a  solution  will  also  remove  recent  stains,  if  followed  by 
the  application  of  a  solution  of  ammonia.  Old  stains  may  be 
removed  with  tincture  of  iodine,  followed  by  cyanide  of 
potassium. 

The  antidote  in  cases  of  poisoning  by  nitrate  of  silver  is 
chloride  of  sodium  (common  salt),  which  converts  it  into 
chloride  of  silver,  to  be  followed  by  emetics,  and  the  proper 
antiphlogistic  treatment. 

DENTAL  FORMULA. 

For  Inflamed  and  Ulcerated  Mucous  For  Ulcers  and  Aphthce. 

Membrane.  jg^.     Argenti  nitratis    .    .    .    .  ^ss 

R.     Argenti  nitratis  .  gr.  ij  to  ^ss  Aquae  destillat^  .    .    .    .  ^j.    M. 

Aquae  destillatee  .    .    .    .  f^j.  M.  Signa. — To  be  applied  with  a  camel- 

SlGNA. — To  be  used  as  a  lotion.  hair  brush. 

For  Diseases  of  the  Antrum.  For  Mercurial  Stomatitis. 

R .     Argenti  nitratis    .  gr.j  to  gr.v  R .     Argenti  nitratis  ....  gr.ss 

Aquae  destillatse .    .    .      fgj.    M.  Aquae  destillatae     .    .    .  f^j.    M. 

Signa. — To  be  used  as  an  injection.  SiGNA. — To  be  used  as  a  mouth  wash. 

ARISTOL— DITHYMOL-DIODIDE— DITHYMOL-BINIODIDE. 

Derivation. — Aristol  is  obtained  by  adding  a  solution  of 
iodine  in  iodide  of  potassium,  to  an  equal  solution  of  hydrate 
of  sodium,  containing  thymol.  It  is  in  the  form  of  a  red  brown 
precipitated  amorphous  non-crystallizable  powder.  The  pro- 
portion of  iodine  in  aristol  has  been  estimated  by  Carius  at 
45.80  per  cent.  Aristol  is  insoluble  in  water  and  glycerine, 
slightly  soluble  in  alcohol,  but  readily  soluble  in  chloroform, 
ether,  and  in  the  essential  oils  ;  but  the  solution  must  be  made 
by  friction  without  heat,  as  the  aristol  is  decomposed  by  heat 
and  also  by  light.  It  possesses  but  a  slight  odor,  like  that  of 
thymol,  and  is  not  unpleasant. 

Medical  Properties  and  Therapeutic  Uses. — Aristol  possesses 
no  irritant  action  upon  the  unbroken  skin,  and  when  applied  to 
mucous  membrane  it  promotes  absorption.  Not  being  absorbed, 
it  has  no  toxic  effect,  and  for  such  reason,  together  with  its  free- 
dom from  disagreeable  odor,  it  possesses  a  great  advantage  over 


ARISTOL.  255 

iodoform.  It  produces  rapid  healing,  and  has  been  employed 
with  benefit  in  varicose  ulcers  as  a  dusting  powder ;  also  in 
cutaneous  diseases,  gonorrhoea,  gleet,  in  operations  of  anal 
fistula,  abscess,  lymphadenitis,  periostitis,  psoriasis,  ulcers, 
etc.,  etc.  It  is  chiefly  employed  as  a  dusting  powder,  or  in 
ethereal  solutions  or  ointments,  epithelioma,  burns  and  scalds. 
Aristol  is  considered  to  be  an  excellent  and  prompt  antiseptic, 
but  the  name  is  merely  an  assumed  one  for  dithymoldic  iodine. 
Impurities  in  aristol  would  be  all  the  by-products  derived  from 
unskilful  treatment;  it  might  contain  potassium  or  sodium 
iodide,  or  free  iodine ;  it  might  be  adulterated  even,  for,  as  a 
patented  article,  it  is  above  control,  as  patents  have  been 
granted  by  the  U.  S.  Patent  Office  for  its  control,  manufacture 
and  sale  under  the  name  of  "  aristol,"  being  a  compound  of 
thymol  with  iodine.  The  virtues  of  aristol  over  iodoform,  etc., 
have  as  yet  not  been  so  pronounced  as  to  exclude  it  from  the 
general  class  of  patented  medicines. 

Dental  Use. — Aristol  has  been  used  as  a  substitute  for  iodo- 
form, iodol,  carbolic  acid,  etc.,  etc.,  in  all  cases  when  the  ordi- 
nary antiseptics  are  indicated,  as  in  gangrenous  pulps,  anti- 
septicizing  of  root-canals,  disinfection  of  cavities  before  the 
introduction  of  fillings,  in  the  form  of  a  lo  per  cent,  solution 
in  sulphuric  ether  for  disinfecting  purposes ;  for  gangrenous 
pulps,  the  aristol  in  solid  form  may  be  applied  with  a  small 
brush.  Sticks  made  of  cacao  butter  lo  parts,  and  aristol  i 
part,  may  be  used  to  promote  granulation  and  healing.  Aris- 
tol has  the  advantage  of  being  effective  in  small  quantities, 
and  may  be  diluted  with  sugar  of  milk. 

Dr.  E.  C.  Kirk  highly  recommends  aristol  for  alveolar 
pyorrhoea,  a  ten  per  cent,  solution  being  rubbed  upon  a  glass 
plate  with  oil  of  cinnamon  and  introduced  into  each  suppu- 
rating pocket,  and  around  the  root  at  the  base  of  each  pocket, 
on  threads  of  absorbent  cotton  saturated  with  the  solution ; 
the  oil  of  gaultheria  may  be  substituted  for  the  oil  of  cinna- 
mon if  desired.  Dr.  Kirk  and  others  also  recommend  aristol 
in  the  essential  oils  as  a  medicament  for  canal-dressings,  and 
as  a  topical  dressing  in  acute  pulpitis.     Dr.  Kirk  recommends 


256  DENTAL  MEDICINE. 


that  as  a  root-canal  dressing,  its  use  should  be  strictly  confined 
to  those  case?  where  pericemental  inflammation  is  not  a  present 
factor,  as  it  does  not  possess  antiseptic  qualities  sufficiently- 
powerful  to  overcome  quickly  septic  conditions  due  to  the 
putrefactive  changes  common  in  root-canals.  He  also  finds  it 
extremely  valuable  in  connection  with  gutta  pereha,  as  an 
antiseptic  in  conjunction  with  permanent  root  fillings — aristol 
with  chloroform  being  used  to  dissolve  the  gutta  pereha.  It 
is  also  recommended  as  an  ingredient  of  nerve  paste,  being 
equal  to  iodoform  for  such  a  purpose,  but  free  from  the  dis- 
agreeable odor  of  the  latter  substance ;  it  is  also  used  in 
chloroform  solution,  instead  of  sandarach  varnish,  for  saturat- 
ing cotton  used  for  wedges  or  temporary  fillings  in  retaining 
medicaments  in  cavities  in  the  teeth ;  such  a  dressing  or  wedge 
may  be  retained  for  days  or  a  week,  and  being  antiseptic,  it  is 
free  from  disagreeable  odor  during  that  time.  Aristol  is  also 
recommended  as  a  dressing  where  approximal  caries  has  ex- 
tended beyond  the  gum  margin,  and  where  hypertrophy  of 
the  gum  festoon  occurs  to  the  degree  of  forming  a  polypoid 
growth  which  invades  the  cavity;  also  in  the  form  of  a  varnish 
it  is  combined  with  collodion  as  a  pulp-capping  material.  To 
increase  the  adhesiveness  of  the  aristol  solution,  a  small  quan- 
tity of  Canada  balsam  may  be  added  to  it. 

ARNICA. 

leopard's  bane. 

Source, — Arnica  Montana  is  a  perennial,  herbaceous  plant 
of  which  the  dried  flowers  and  root — Amices  Flores  and  ArniccE 
Radix — are  the  medicinal  portions,  and  is  found  in  the  moun- 
tains of  Northern  Europe  and  the  Northwestern  portions  of 
America, 

Medical  Properties  and  Action. — Arnica  is  nervine,  stimulant, 
and  diaphoretic.  In  over- doses,  it  is  an  acro-narcotic  poison, 
causing  vomiting,  purging,  vertigo,  tetanic  twitching  of  the 
muscles,  and  convulsions.  Moderate  doses,  when  long  con- 
tinued, are  liable  to  cause  a  very  troublesome  eruption.     Its 


ARNICA. 


257 


activity  depends  upon  an  alkaloid — Arnici?ia,  which  is  a  bitter 
and  acrid  extractive. 

Therapeutic  Uses. — Arnica  is  administered  internally  in 
typhus  and  typhoid  fevers,  chronic  dysentery,  rheumatic  gout, 
etc.,  etc.  Externally  to  bruises,  sprains,  lacerations,  chilblains, 
etc.,  in  the  form  of  tincture — Tinctura  Arnica.  The  antidote 
for  poison  by  arnica  is  common  vinegar. 

Dose. — Of  the  extract  of  arnica,  gr.  v  to  gr.  x.  Of  the 
tincture  of  arnica  (arnica  root  Sj,  rectified  spirit  Oj),  the  dose 
is  Tttx  to  f5ss. 

Dental  Uses. — In  dental  practice,  the  tincture  of  arnica  is 
applied  to  irritable  pulps  of  teeth,  in  periodontitis  to  prevent 
suppuration,  to  wounds  of  the  mucous  membrane  of  the 
mouth,  combined  with  glycerine,  to  abraded  surfaces  caused 
by  artificial  teeth,  and  with  tannic  acid  or  glycerine  of  tannin 
for  ulcers  of  the  mouth. 

The  tincture  of  arnica,  when  largely  diluted  with  water, 
forms  an  efficient  mouth  wash  during  operations  upon  the 
teeth.  Equal  parts  of  tincture  of  arnica  and  glycerine  diluted 
with  water  form  an  effective  mouth  wash  in  inflammations  of 
the  mucous  membrane  of  the  mouth. 


For   Abraded  Surfaces   of   the  Mucous 

Membrane  of  the  Mouth. 
R .     Tinctune  amicae, 

Glycerini     .    .  aa  .    .    .  ^j.     M. 
SiGNA. — To  be  used  as  a  lotion. 


DENTAL  FORMULA. 

For  Ecchymosis. 

U.  Tincturae  Amicae  .  .  .  ^ss 
Liquor  ammonii  muriat.  ^  ss 
Aquae ^^v. 

SiGNA. — To  be  used  as  a  lotion. 


M. 


Astringent  Mouth   Wash  in  Alveolar 

Pyorr/uBa,  etc. 

DR.    J.    R.    BELL, 

R.     Tincturae  Amicae  .    .    .  ^j 
Acidi  carbolici  ....  tT^xx 
Tincturae  myrrhae    .    .  J  ss 
Olei  gaultheriae  .   .    .    .  ^jss 


For  Inflamed  and  Ulcerated  Mucous 
Membrane. 

R .     Tincturae  amicae    .    .    .  ,^  ij 

Glycerini ^ij 

Aquae  rosee ^  ij 

Aquae  destillatae    .    .    .  ^x.     M. 


Alcoholis 3  ijss   M.       Signa, — To  be  used  as  a  gargle. 


»7 


258  DENTAL   MEDICINE. 


ATROPINE  SULPHAS— SULPHATE  OF  ATROPINE. 
ATROPINE. 

Formula. — CiyHggNOg. 

Derivation. — Sulphate  of  Atropine  is  obtained  by  adding  a 
mixture  of  sulphuric  acid  to  an  ethereal  solution  of  atropine. 
It  is  in  the  form  of  a  white,  slightly  crystalline  powder,  very 
soluble  in  water  and  alcohol,  but  insoluble  in  ether.  It  is  in- 
odorous, and  of  a  bitter  taste. 

Medical  Properties  and  Action. — Sulphate  of  atropine  has  the 
same  medical  properties  and  action  as  belladonna,  of  which 
it  is  the  alkaloid,  but  is  far  more  energetic  in  its  action.  It  is 
an  active  poison,  and  should  only  be  administered  internally 
with  the  greatest  care.  Hypodermically  employed,  it  is  a 
useful  anodyne  and  antispasmodic,  and  the  quantity  should  be 
cautiously  increased  from  a  very  small  dose  in  the  beginning. 
Such  symptoms  as  dryness  of  the  throat,  vertigo,  and  diplopia, 
are  indications  that  its  use  should  be  discontinued.  Without 
being  a  direct  hypnotic,  it  induces  sleep  by  relieving  pain. 
Although  it  is  not  so  well  tolerated,  as  a  general  rule,  as  is 
morphine,  yet  patients  who  cannot  bear  morphine  will  bear 
atropine. 

Therapeutic  Uses. — See  Belladonna. 

Dose. — Of  sulphate  of  atropine,  gr.  yi^  to  gr.  Jg-.  For  an 
anodyne  and  antispasmodic,  hypodermically  injected,  the  dose 
is  ifllij=gr.  xg-Q^,  as  a  commencement.  An  ointment  is  made 
of  atropine  gr.  viij,  rectified  spirit  f5ss,  lard  oj. 

The  antidote  in  cases  of  poisoning  by  Belladonna  and  its 
alkaloid  is  an  infusion  of  galls  and  lime  water,  first  evacuating 
the  stomach  as  speedily  as  possible. 

Dental  Uses. — In  dental  practice,  sulphate  of  atropine  is 
applied  externally  to  obtund  the  sensitiveness  of  inflamed 
pulps  of  teeth,  preparatory  to  their  treatment,  and  to  their 
devitalization ;  it  is  also  applied  to  acute  inflammation,  depend- 
ing upon  alveolar  periostitis  and  abscess.  It  forms  one  of  the 
ingredients  of  a  nerve  paste,  for  devitalizing  pulps  of  teeth, 
being  substituted  for  the  acetate  of  morphine,  but  there  is 


SULPHATE  OF  ATROPINE. 


259 


doubt  as  to  its  being  so  efifective  as  the  morphine  salts ;  in 
facial  neuralgia,  in  the  form  of  an  ointment ;  in  neuralgia  and 
in  profuse  salivation.  As  an  anodyne  for  internal  use,  it  proves 
efficacious  in  relieving  intense  pain,  such  as  may  result  from 
an  inflamed  pulp  or  periosteum ;  also  internally,  or  in  the  form 
of  hypodermic  injections,  for  the  relief  of  facial  neuralgia; 
for  such  a  purpose  yt^  of  a  grain  of  the  atropine  sulphate  is 
often  combined  with  morphine  sulphate. 


DENTAL  FORMULA. 


Far  Facia/  Neuralgia. 
R .     Atropinse  sulphat  .    .    .  gr.j 

Adipis ^].       M. 

SiGNA. — To  be  applied  in  the  form  of 
an  ointment,  over  seat  of  pain. 


R. 


For  Neuralgia, 

J.  L.  Ludlow. 

Atropinae  sulphatis    .    .  gr.ss 


Aconitinae  .    .    . 

Olei  tiglii    .    .    . 

Ung.  petrolei .    . 

SiGNA. — Apply  externally, 


.  gr.iss 
•  gttij 


M. 


For  Facial  Neuralgia. 
R .     Pulveris  belladonnse  .    .  ^  x 

Camphorse ^  ss 

Spiritus  rectificati  .    .    .  q.s.       M. 
SiGNA. — To  be  applied  with  a  camel- 
hair  bnish. 

For  Neuralgia  of  Superficial  Nerves, 
AlTKEN. 

R.     Atropinae  sulphat  .    .    .  gr.v 

Aquse  destillat    ....  f5iii.  M. 
SiGNA. — Use  on  a  compress  and  renew 


several  times  in  24  hours,  and  con- 
tinue for  at  least  one  hour  at  a  time, 
covering  with  oilskin,  to  prevent 
evaporation. 


For  Facial  Neuralgia. 
R.     Ext.  belladonnae    .    .    .  gr.ss 
Quininae  sulphat    .    .    .  gr.ij. 
Ft.  pil.  No.  I. 
SiGNA. — Use  three  times  daily. 


M. 


For  Facial  Neuralgia. 
R .     Linimenti  belladonnse, 

Linimenti  aconiti   .  aa  .    7^  vij 

Chloroformi f,5ij-    M. 

SiGNA. — To  be  applied  as  a  lotion,  on 
lint  saturated  with  it,  and  covered 
with  oiled  silk. 

For  Neuralgia  in  Superficial  Nerves. 

R .     Chloroformi, 

Spts.  vini  rect.   .  aa  .  .  ^  ss 
Atropinae  sulphat   .    .  .  gr.v.     M. 
SiGNA. — To  be  applied  on  lint  to  pain- 
ful   part,    and    covered  with    oiled 
silk. 


For  Neuralgia, 

R.     Ext.  belladonnae gr.iv 

Ext.  stramonii gr.v 

Ext,  hyoscyami gr.v 

Quininae  sulphat ^ij.      M. 

Ft,  pil.  No.  XX. 
SiG.NA. — One  pill  two  or  three  times  a  day. 


260  DENTAL   MEDICINE. 


AURUM  TERCHLORIDUM— TERCHLORIDE  OF  GOLD. 

Formula. —  Au  CI  3 . 

Derivation. — The  Terchloride  of  Gold  is  obtained  by  dis- 
solving gold  in  aqua  regia  (three  parts,  by  measure,  of  hydro- 
chloric acid,  and  one  of  nitric  acid)  using  gentle  heat  to  has- 
ten the  solution,  the  acids  employed  being  chemically  pure. 
The  solution  is  then  evaporated  to  dryness,  when  ruby-red, 
prismatic  crystals  of  the  terchloride  of  gold  result. 

Properties  a7id  Action. — Terchloride  of  gold  is  very  deli- 
quescent, and  is  soluble  in  water,  alcohol  and  ether.  It  pos- 
sesses a  disagreeable,  styptic  taste,  reddens  blue  litmus  paper 
and  will  impart  a  purple  stain  to  the  skin,  which  may  be  re- 
moved by  a  solution  of  cyanide  of  potassium.  It  is  readily 
decomposed  by  many  metallic  and  non-metallic  elements,  and 
also  by  saline  and  organic  compounds,  on  account  of  its  ele- 
ments being  held  together  by  a  feeble  affinity.  It  is  escharotic 
and  disinfectant,  and  its  physiological  effects  are  similar  to 
those  of  corrosive  sublimate.     It  is  not  used  internally. 

Dental  Uses. — In  dental  practice,  the  terchloride  of  gold,  in 
the  form  of  an  aqueous,  alcoholic,  or  ethereal  solution,  is  em- 
ployed for  the  purpose  of  obtunding  the  sensitiveness  of  dentine, 
for  which  it  is  a  valuable  application :  and  the  ethereal  solu- 
tion possesses  some  advantages  over  the  aqueous  or  alcoholic 
solutions  for  such  a  purpose.  To  prepare  an  obtunding  solu- 
tion:  "Dissolve  the  crystals  of  the  gold  in  pure  water;  fill  a 
test  tube  half  full  of  the  solution ;  then  add  an  equal  quantity 
of  sulphuric  ether,  and  agitate  the  mixture.  Let  it  then  rest 
for  a  few  minutes,  when  the  ethereal  solution  will  rise  to  the 
surface,  and  may  be  poured  off  into  another  tube  or  phial,  and 
securely  stopped.  It  should  be  kept,  as  much  as  practicable, 
from  the  action  of  light  and  air.  Applied  to  dentine,  on 
pledgets  of  cotton,  it  acts  like  chloride  of  zinc,  but  more 
promptly  and  with  less  pain.  Chlorine  is  more  abundantly 
liberated  during  its  action  than  from  chloride  of  zinc  ;  hence  it 
is  a  better  disinfectant  than  the  latter.  It  has  a  fine  yellow 
tint,  and  it  is  not  absorbed  by  the  dentine,  but  forms  an  in- 


BELLADONNA.  261 


soluble  compound  with  the  gelatinous  elements.  As  it  is  an 
irritant  poison,  care  should  be  observed  in  its  use.  If  not 
protected  in  a  glass-stoppered  bottle,  the  gold  is  precipitated 
in  a  metallic  form. 

BELLADONN.^  FOLIA— BELLADONNA  LEAVES. 

BELLADONNA  RADIX— BELLADONNA  ROOT. 
DEADLY    NIGHTSHADE. 

Source. — Belladonna  is  a  perennial,  herbaceous  plant,  found 
in  Europe,  the  leaves  and  root  being  the  medicinal  portions. 

Medical  Properties  and  Action. — Belladonna  is  anodyne  and 
antispasmodic,  its  activity  depending  upon  an  alkaloid,  Atro- 
pine. Belladonna,  in  small  doses,  is  a  valuable  narcotic  and 
anodyne  stimulant.  It  causes  a  peculiar  dryness  of  the  mouth, 
fauces,  stomach  and  intestines,  but  increased  secretion  follows, 
especially  in  the  case  of  the  latter  organs,  when  atropine  is 
administered  or  subcutaneously  injected.  In  larger  doses,  it 
causes  dilatation  of  the  pupils,  giddiness,  loss  of  vision,  difficult 
deglutition,  constriction  of  the  throat,  difficult  articulation, 
increased  action  of  the  heart,  quickened  respiration,  nausea, 
vomiting,  diuresis,  purging,  and  sometimes  a  red  eruption.  It 
is  eliminated  chiefly  by  the  urine. 

Opium  is  the  antidote,  or  hypodermic  injections  of  mor- 
phine. When  applied  to  the  eyebrows,  belladonna  causes 
dilatation  of  the  pupils. 

Therapeutic  Uses. — Belladonna  is  extensively  employed, 
either  alone  or  in  combination  with  sulphate  of  quinia,  in  the 
treatment  of  neuralgia  ;  also  in  mania,  Bright's  disease,  epi- 
lepsy, lead  colic,  spasmodic  affections,  diseases  of  the  cerebro- 
spinal system,  as  a  preventive  of  scarlatina,  night  sweats  of 
phthisis,  etc. 

Dose. — Of  powdered  belladonna,  gr.  ss  to  gr.  j.  daily ;  of 

the  extract,  gr.  ]^  to  gr.  j  ;  of  the  tincture,  gtt.  v  to  gtt.  xx. 

(See  Atropine.) 

BENZOIC   SULPHIDE    OF   SODIUM. 

Benzoic  Sulphide  of  Sodium  is  obtained  by  dissolving  a 
large  quantity  of  benzoic  acid  in  a  concentrated  solution  of 


262  DENTAL   MEDICINE. 


sulphide  of  sodium.  It  is  a  valuable  antiseptic  for  dressing 
wounds,  arid  may  be  used  as  a  wash,  lotion  or  injection,  its 
antiseptic  properties  being  very  active  and  healing.  Thirty  to 
forty-five  grains  are  used  to  the  quart  of  water.  Heckel  con- 
siders it  to  be  equal  to  carbolic  acid,  and  superior  both  to 
sublimate  and  iodoform,  as  it  is  not  poisonous  like  corrosive 
sublimate,  and  is  free  from  the  disagreeable  effects  of  iodo- 
form. It  is  very  soluble  in  water  and  contains  the  antiseptic 
properties  of  its  two  principal  ingredients — benzoic  acid  and  sul- 
phite of  sodium.    It  is  harmless,  even  when  given  in  large  doses. 

BISMUTHI  SUBNITRAS— SUBNITRATE  OF  BISMUTH. 

Formula.— BiONOgU^O. 

Derivation. — The  metal  Bismuth — Bismuthum,  Formula  Bi, 
from  which  the  subnitrate  is  obtained,  is  found  native  in 
Europe  and  America,  and  generally  in  combination  with  sul- 
phur and  oxygen.  It  fuses  at  476°  F.,  and  is  brittle  and 
pulverizable.  It  is  employed  in  the  dental  laboratory  for 
making  fusible  metal  alloys  for  dies  and  counter-dies. 

The  Subnitrate  of  Bismuth  is  obtained  by  dissolving  the 
metal  bismuth  in  dilute  nitric  acid,  and  converting  the  nitrate 
thus  formed  into  carbonate,  by  adding  a  solution  of  carbonate 
of  sodium,  which  is  then  dissolved  in  nitric  acid  and  the 
nitrate  of  bismuth  again  formed,  which  is  washed  in  water 
and  the  nitric  acid  removed  by  ammonia.  Such  a  process 
frees  it  from  the  arsenious  acid  which  metallic  bismuth  gen- 
erally contains.  Subnitrate  of  bismuth  is  in  the  form  of  a 
heavy,  white  powder,  with  a  faint  acid  odor  and  slightly 
metallic  taste,  and  is  insoluble  in  water.  Large  quantities  are 
poisonous,  with  symptoms  of    arsenical  poisoning. 

Medical  Properties  and  Action. — Subnitrate  of  bismuth  is 
sedative,  astringent  and  alterative.  Owing  to  the  formation 
of  a  sulphide,  it  coats  the  tongue  black,  and  its  continued  use 
may  give  rise  to  the  formation  of  a  bluish-red  line  on  the 
gums,  similar  to  that  resulting  from  the  use  of  lead,  except 
that  the  line  is  wider  and  deeper  in  color.  In  proper  doses,  it 
promotes  the  appetite  and  increases  the  digestive  power.    Being 


SUBNITRATE  OF   BISMUTH.  263 

somewhat  astringent,  it  affects  the  intestinal  movements,  and 
can  be  detected  in  the  blood,  urine,  and  other  secretions. 

Therapeutic  Uses. — Subnitrate  of  bismuth  is  employed  in 
atonic  dyspepsia,  gastric  irritations  (milder  forms),  pyrosis, 
gastrodynia,  ulcer  of  the  stomach,  diarrhoea  from  debility,  etc., 
chronic  laryngitis,  epilepsy,  ringworm  (in  form  of  an  oint- 
ment 5j  to  lard  5j),  chronic  skin  diseases,  chlorosis,  when  iron 
is  not  tolerated,  etc.,  etc.  If  not  well  borne  by  the  stomach, 
it  may  be  combined  with  aromatic  powder,  or  if  alkalies  are 
indicated,  with  chalk  and  magnesia. 

Bismuthi  subnitras  is  also  employed  as  an  antiseptic  dress- 
ing for  wounds,  to  promote  primary  union.  The  subnitrate  is 
held  in  suspension  in  water,  in  the  proportion  of  lo  per  cent., 
and  during  the  operation  the  wound  is,  from  time  to  time, 
sprinkled  with  the  solution,  and  afterward  sealed  with  a  bis- 
muth paste,  and  the  subsequent  dressings  made  in  the  same 
manner. 

Dose. — Of  subnitrate  of  bismuth,  grs.  v-x  to  5j,  in  powder 
or  emulsion. 

Dental  Uses. — Subnitrate  of  bismuth  is  a  valuable  internal 
remedy  in  aphthae,  mercurial  salivation,  painful  ulcers  of  the 
mucous  membrane  of  the  mouth,  vomiting,  cholera  infantum, 
and  diarrhoea  of  children  during  painful  dentition.  It  is  best 
given  in  milk,  and  before  meals. 

For  cancrum  oris,  after  using  a  disinfecting  solution  to 
cleanse  the  gangrenous  part,  the  topical  application  of  sub- 
nitrate of  bismuth,  every  three  hours,  corrects  the  fetor,  arrests 
the  progress  of  the  gangrene,  and  hastens  cicatrization. 

DENTAL   FORMULAE. 

For  Vomiting  and  Painful  Digestion  of      SiGNA. — A    tablespoonful     for    adults, 
Teething  Children,  Acidity  and  Pyro-  and  proportionate   quantity   for  chil- 

sis.  dren  three  or  four  times  a  day. 

BarthoI-OW. 

R  .     Bismuthi  subnitrat       .   3  iij  ^'"'  Gangrene  of  Mouth  ( Cancrum  Oris). 

Acidcarhol gr.  ij-gr.  iv  B-     Bismuthi  subnitras  (powd.). 

Mucil.  acacix-  .    .    .    .   .^j  SiGNA. — Applied  to  ulcerated  surface, 
Aquai  menthec  pip  .    .   .^iij.      M,  and  covered  with  absorbent  cotton. 


264  DENTAL   MEDICINE. 


For  Diarrhcea  of  Dentition.  water,  milk  and  lime  water.    Starchy 

R .     Bismuthi^  subnitrat  .    .  gr.lx  ^od  prohibited 


Extract    rhei   fluid  .    .  gtt.  viij 
Syrup    rubus     .    .    .    .  f  ^  ss 
Elixir  aurantii  .    .    .    .  f  ^  ss.  M. 


For  Internal  Administration  to  Support 
the  Strength. 

R .     Quininae  sulphat  .    ,    .  gr.  iij  to  v 
SlGNA. — A    teaspoonful     four    or    six  Tinct.  ferri  chloridi  .    .  gtt.  v.    M. 

times  a  day.     Proper  feeding — ^barley       Signa. — Three  time  daily. 


BROMIDES. 

Bromides  are  diffusible  agents  which  rapidly  pass  into  the 
blood,  and  in  large  doses  can  be  detected  in  the  faeces  and 
intestinal  mucus,  owing  to  a  portion  of  the  agent  not  being 
absorbed.  They  depress  the  heart's  action,  and  also  respiration 
and  animal  temperature ;  in  some  cases  large  doses  may  cause 
transient  excitement,  giddiness  and  intoxication.  Moderate 
doses  have  a  tranquillizing  effect  and  refreshing  sleep,  and 
lower  the  sensibility  to  pain  and  irritation.  Their  immoderate 
use  will  cause  paralysis  of  the  muscles,  and  a  condition  known 
as  bromism,  the  symptoms  of  which  may  be  extreme  pallor 
and  anaemia,  dilated  pupils,  slow  and  feeble  action  of  the 
heart,  breathlessness  and  quickened  pulse  on  slight  exertion, 
acne,  skin  eruption,  cool  extremities,  tremulous  and  uncertain 
movements,  want  of  tactile  feeling,  relaxation  of  the  genitals, 
dry  fauces,  difficult  deglutition,  and  weak  mind. 

Ammonii  Bromidum — Bromide  pf  Ammonium,  Formula. 
— NH4Br.  In  the  form  of  colorless,  transparent  crystals,  or  a 
white  granular  salt,  with  a  pungent,  saline  taste,  neutral  re- 
action, and  no  odor.  Ammonii  Bromidum  is  soluble  in  1.5 
parts  of  water,  in  150  parts  of  alcohol  at  60°  F.,  and  in  0.7 
part  of  boiling  water. 

Dose. — Gr.  x  to  5ss,  considerably  diluted. 

Calcii  Bromidum — Bromide  of  Calcium.  Formula. — 
CaBrg.  In  the  form  of  a  white  granular,  deliquescent  salt, 
with  a  pungent,  saline,  bitter  taste,  and  no  odor.  It  has  a 
neutral  reaction,  and  is  soluble  in  0.7  part  of  water,  and  in  i 
part  of  alcohol. 

Dose. — 9j  to  5ij. 


BROMIDES.  265 


LiTHii  Bromidum — Bromide  of  Lithium,  Formula. — 
LBr.  In  the  form  of  white,  granular,  deliquescent  salt,  with 
a  pungent,  bitter  taste,  and  a  neutral  reaction.  Quite  soluble 
in  water  and  alcohol. 

Dose. — Gr.  v  to  3ij. 

SoDii  Bromidum — Bromide  of  Sodium.  Formula. — NaBr. 
In  the  form  of  small,  colorless  crystals,  or  a  white  crystalline 
powder,  with  a  saline  taste,  neutral  reaction,  and  no  odor.  It 
is  soluble  in  1.6  parts  of  water,  and  in  200  parts  of  water  at 
60°  F. 

Dose. — 9j  to  5ii.      (See  Bromides  of  Potassium,  Camphor  ■ 
and  Ethyl.) 

Aledical  Properties  and  Therapeutic  Uses. — The  bromides 
have  the  same  general  action  and  are  employed  for  the  same 
purposes.  The  bromide  of  lithium  is  considered  to  have  a 
more  hypnotic  influence  than  the  others ;  and  the  bromide  of 
sodium  is  generally  given  in  full  doses ;  the  others  in  rather 
smaller  doses.  Prof  Bartholow  considers  the  bromide  of 
potassium  to  possess  more  toxic  power,  and  the  bromide  of 
sodium  the  least.  As  regards  their  influence  on  the  pulse, 
body-head,  and  respiration,  the  same  author  places  the  bro- 
mides in  the  following  order:  bromide  of  sodium,  bromide  of 
lithium,  bromide  of  potassium,  bromide  of  ammonium.  The 
bromides  are  eliminated  through  the  kidneys  chiefly ;  also 
through  the  mucous  membrane  of  fauces,  bronchi,  intestinal 
canal  and  the  skin ;  several  days  being  required  for  their  dif- 
fusion outwardly  from  the  blood.  The  bromides  are  admin- 
istered in  delirium  tremens,  insanity,  increased  action  of  the 
heart,  tetanus,  neuralgia,  epilepsy,  vaso-motor  disturbances, 
spasmodic  asthma,  abnormal  sexual  excitement,  nocturnal  sem- 
inal emissions,  vomiting  of  cerebral  congestion,  pregnancy 
and  sea-sickness,  cholera  infantum,  migraine,  strychnine-pois- 
oning, etc.,  etc.  Locally  in  pruritus,  prurigo,  eczema,  epithe- 
lioma, old  ulcers,  etc.  (For  Dental  Uses,  see  Bromide  of  Po- 
tassium.) 


266  DENTAL   MEDICINE. 


BROMOL— TRI-BROM-PHENOL,  BROMO-PHENOL. 

Formula. — CgHgBr.gHO. 

Derivation. — Bromol  is  a  compound  of  bromine  and  carbolic 
acid.  It  is  in  the  form  of  soft,  white  needles,  and  is  prepared 
by  treating  phenol  or  carbolic  acid  with  an  excess  of  bromine 
in  aqueous  solution. 

Medical  Properties  and  Therapeutic  Uses. — Bromol  possesses 
strong  antiseptic  properties,  and  at  the  same  time  is  non-toxic. 
Rademaker  recommends  it  for  external  use,  either  dissolved 
in  olive  oil  (i  in  30)  or  mixed  with  vaseline  (4  in  40).  It  may 
also  be  employed  in  the  form  of  powder  like  iodoform,  for 
sprinkling  in  wounds. 

It  is  also  used  internally  in  cholera  infantum,  typhoid  fever, 
etc.,  etc. 

Dose. — For  internal  administration,  the  dose  of  bromol  is 
from  -Y^to  \  grain. 

Dental  Uses. — The  uses  of  bromol  in  dental  practice  are  the 
same  as  iodol,  iodoform  and  other  antiseptics.  Good  results 
have  been  obtained  by  its  application  to  teeth  affected  with 
alveolar  abscess  and  gangrenous  pulps, 

CADMII  SULPHAS— SULPHATE  OF  CADMIUM. 

Formula.— I  (CdCSOg)  +  SHO. 

Derivation. — Sulphate  of  Cadmium  is  obtained  by  the  action 
of  nitric  acid,  diluted  with  distilled  water,  on  the  metal  cad- 
mium, the  solution  filtered  and  mixed  with  carbonate  of  soda, 
and  again  dissolved  in  sulphuric  acid  diluted  with  distilled 
water.  It  is  in  the  form  of  transparent,  colorless  crystals,  like 
those  of  sulphate  of  zinc. 

Medical  Properties  and  Action. — Sulphate  of  cadmium  is 
emetic  and  astringent,  and  closely  resembles  sulphate  of  zinc 
in  its  action,  but  is  stronger,  with  a  caustic  astringent  taste. 
It  is  very  nauseant  and  depresses  greatly.  Locally  it  is  an 
irritant  poison,  and  produces  the  cerebro-spinal  symptoms  of 
coma  and  convulsions ;  it  is  not  administered  internally,  as 
the  preparations  of  zinc  are  preferable  for  such  use. 


HYPOPHOSPHITE   OF  LIME.  267 

Therapeutic  Uses. — Sulphate  of  cadmium  is  employed  locally 
in  affections  of  the  eye,  being  valuable  as  a  collyrium;  it  has 
the  power  of  causing  absorption  of  opacities  of  the  cornea  to 
a  remarkable  degree.  It  is  also  used  as  an  injection  in  gon- 
orrhoea, in  the  strength  of  one  grain  to  four  ounces  of  water. 
It  is  also  used  in  the  form  of  ointment,  two  grains  with  four 
scruples  of  lard. 

Dejital  Uses. — Sulphate  of  cadmium  has  been  employed  in 
ulcerations  of  mucous  membrane,  gangrene  of  the  mouth,  or 
cancrum  oris,  indolent  ulcers,  purulent  diseases  of  the  antrum, 
in  the  form  of  injections  and  lotions,  of  a  strength  about  one 
grain  of  the  sulphate  to  four  ounces  of  water. 

CALCII  HYPOPHOSPHIS— HYPOPHOSPHITE   OF   LIME. 

Formula. — CajPHjOg. 

Derivation. — The  salt,  Hypophosphite  of  Lime,  is  obtained 
by  boiling  phosphorus  in  a  mixture  of  hydrate  of  lime  in  boil- 
ing water,  until  phosphoretted  hydrogen  escapes,  and  phos- 
phate and  hypophosphite  of  lime  are  formed  in  the  solution, 
which  is  then  filtered  and  evaporated  over  sulphuric  acid, 
when  the  salt  is  crystallized  out  in  the  form  of  white,  pearly 
crystals,  with  a  nauseous,  bitter  taste.  It  is  soluble  in  six 
parts  of  water,  but  is  insoluble  in  alcohol. 

Medical  Properties  and  Action. — The  hypophosphite  of  lime, 
with  those  of  soda  and  potassa,  are  all  included  under  the 
term  "alkaline  sulphites."  Taken  internally,  they  are  readily 
absorbed,  and  are  partially  changed  in  the  system  into  sul- 
phates. They  combine  with  acids  to  form  salts,  and  they  dis- 
solve albumen,  and  increase  the  formation  of  saliva.  Being 
regarded  as  tonic,  alterative,  stimulant  and  nervine,  they  are 
employed  in  cases  of  debility,  more  especially  where  the  phos- 
phates are  deficient,  as  they  possess  the  therapeutic  properties 
of  phosphorus. 

Therapeutic  Uses. — The  different  sulphites  of  lime,  soda, 
and  potassa,  are  employed  in  intermittent  and  malarious  fevers, 
typhus  fever,  smallpox,  and  other  exanthematous  diseases, 
pyaemia,  dyspepsia,  neuralgia  with  nervous  depression,  anaemia, 


268  DENTAL   MEDICINE. 


for  which  affections  they  are  combined  with  iron  and  quinine; 
diphtheria, -cystitis,  phthisis,  etc.,  etc.  Externally,  the  sul- 
phites are  efficient  as  local  applications  (especially  the  sul- 
phites of  soda),  in  gangrenous  and  other  ulcerations,  diseases 
of  the  skin,  etc.  One  or  two  ounces  to  the  pint  of  water 
form  a  stimulant  and  deodorizing  lotion,  which  is  promotive 
of  healthy  action. 

Dose. — Of  the  hypophosphites,  gr.  iij  to  gr.  xv,  three  times 
a  day  in  syrup. 

Dental  Uses. — The  hypophosphite  of  lime  is  the  most  eli- 
gible salt,  but  the  different  sulphites  are  often  administered 
together,  in  the  form  of  a  syrup.  Where  there  is  nervous 
depression,  as  a  result  of  trigeminal  neuralgia,  the  hypo- 
phosphites  prove  serviceable.  In  the  case  of  delicate  chil- 
dren, where  there  is  reason  for  believing  the  phosphate  of 
lime,  or  the  lime  salts  generally  of  the  teeth,  are  deficient  in 
quantity. 

CALENDULA. 
MARIGOLD. 

Source. — Calendula  is  a  well-known  garden  plant,  some- 
times growing  wild,  with  a  peculiar  and  rather  disagreeable 
odor,  and  a  bitter,  rough,  saline  taste.  Both  the  leaves  and 
the  flowers  are  employed. 

Medical  Properties  and  Action. — It  is  slightly  stimulant, 
diaphoretic,  antispasmodic,  sudorific,  and  emmenagogue,  but 
is  seldom  used  internally.  It  contains  a  bitter  principle 
known  as  calendidin. 

Therapeutic  Uses. — Calendula  has  been  employed  in  low 
forms  of  fevers,  scrofula,  jaundice,  amenorrhoea,  etc.  Ex- 
ternally it  is  used  in  the  form  of  tincture — Tinctnra  Calendula 
— in  its  full  strength  or  diluted,  and  is  very  serviceable  in 
exercising  a  curative  influence  in  the  treatment  of  incised 
wounds  and  contusions,  preventing  inflammation  and  suppura- 
tion. Some  writers  consider  it  to  be  unequaled  as  a  local 
application  after  surgical  operations,  as  it  promotes  union  by 
first  intention.  It  is  applied  as  a  lotion  on  lint.  It  is  also 
thought  to  be  a  preventive  against  gangrene  and  tetanus. 


CALCIUM.  269 

Dose. — Of  the  tincture  of  calendula,  f3j  to  f5ij. 

Dental  Uses. — Calendula,  in  the  form  of  tincture,  is  em- 
ployed in  dental  practice  as  an  application  to  wounded  or 
irritated  pulps  of  teeth,  when  partially  exposed ;  also  after  the 
extraction  of  teeth ;  wounds  about  the  mouth ;  and  in  such 
cases  it  proves  a  very  useful  remedy.  A  few  drops  added  to  a 
wine-glass  of  water  form  a  soothing  and  efficient  mouth-wash 
for  the  soreness  resulting  from  the  removal  of  salivary  cal- 
culus ;  also  useful  in  superficial  inflammations  of  the  mucous 
membrane  of  the  mouth,  etc. 

CALX— CALCIUM. 
LIME. 

Formula. — CaO. 

Derivation. — Lime  is  obtained  by  calcining  limestone  or 
chalk,  until  the  carbonic  acid  is  driven  off  Lime  is  more 
soluble  in  cold  than  in  hot  water,  and  a  compound  of  lime 
and  sugar  is  more  soluble  in  water  than  pure  lime  alone. 
Calcium  is  the  metallic  base  of  lime. 

Medical  Properties  and  Action. — Quicklime  is  a  powerful 
escharotic  and  irritant. 

Liquor  Calcis — Lime  Water. — It  is  prepared  by  adding 
cold  water  to  freshly  slacked  lime,  and  the  clear  fluid  poured 
off 

The  officinal  preparation  consists  of  four  troy  ounces  of 
saturated  solution  of  lime  in  eight  pints  of  distilled  water.  It 
is  a  colorless,  inodorous  liquid,  possessing  a  disagreeable 
alkaline  taste. 

Exposure  to  the  air  causes  it  to  gradually  absorb  carbonic 
acid,  with  the  formation  of  insoluble  carbonate  of  lime,  and  it 
should  therefore  be  preserved  in  glass-stoppered  bottles.  The 
addition  of  liquorice  or  coriander  seed  will  disguise  its  taste. 

Medical  Properties  and  Action. — Lime  water  is  antacid, 
astringent,  antiseptic  and  detergent.  It  is  applicable  to  all 
cases  where  antacids  are  indicated,  and  where  an  astringent 
effect  is  not  objectionable. 

Therapeutic  Uses. — Lime  water  is  an  excellent  remedy  in 
gastric   irritation,   accompanied    with   nausea   and  vomiting; 


270  DENTAL   MEDICINE. 


also  in  dyspepsia,  attended  with  vomiting  of  food ;  also  in 
diarrhoea,  "after  the  inflammatory  action  has  been  relieved; 
also  in  glandular  affections,  as  an  alterative  resolvent.  Ex- 
ternally, as  a  wash  for  foul  ulcers,  diseases  of  the  skin,  and 
as  an  injection  in  gleet  and  leucorrhoea.  Atomized  inhalations 
have  been  found  useful  in  diphtheria  and  membranous  croup. 

Dose. — Of  lime  water,  f^ss  to  fgiij  or  iv,  several  times  a 
day.  It  may  be  mixed  with  an  equal  quantity  of  milk  for 
internal  use. 

Lime  liniment — Linimentum  Calcis  (lime  water  foviij,  flax- 
seed oil  Svij) — is  a  valuable  application  to  burns,  scalds  and 
in  small-pox. 

Dental  Uses. — In  dental  practice  lime  water  is  a  useful  agent 
in  the  form  of  a  gargle,  where  the  secretions  of  the  mouth  are 
viscid  and  fetid,  and  especially  where  the  teeth  are  soft  in 
structure  and  exceedingly  sensitive,  owing  to  the  condition  of 
the  oral  fluids,  and  especially  in  mucous  secretions,  which  act 
readily  on  teeth  deficient  in  earthy  constituents.  For  young 
patients,  the  use  of  lime  water  is  very  beneficial  to  the  teeth, 
owing  to  an  acid  condition  of  the  oral  fluids,  common  to  an 
early  period  of  life.  It  is  also  useful  where  the  teeth  are  very 
sensitive,  on  account  of  the  recession  of  the  gum  and  absorp- 
tion of  the  process. 

When  lime  water  is  applied  to  inflamed  mucous  membrane, 
or  to  suppurating  surfaces,  it  arrests  secretion.  It  is  also  useful 
in  sickness  and  irritability  of  the  stomach  during  dentition ; 
also  to  relieve  the  superficial  ulceration  of  the  mucous  mem- 
brane of  the  mouth,  caused  by  the  acid  eructations  attending 
dyspepsia,  in  the  proportion  of  one  part  of  lime  water  to  two 
or  three  of  milk. 

Syrup  of  the  Lacto-phosphate  of  Lime. — Syrupus  Calcii 
Lacto-phosphatis — is  composed  of  precipitated  phosphate  of 
calcium  22  parts;  lactic  acid  33  parts;  orange  flower  water 
80  parts ;  sugar  600  parts ;  hydrochloric  acid,  water  of 
ammonia  and  water,  each,  a  sufficient  quantity. 

Dose. — fSj  to  fSj. 

This  syrup  is  especially  useful  in  rickets,  moUities  ossium, 


CHLORINATED   LIME.  271 

delayed  union  of  fractures,  caries  and  necrosis  in  bone,  anaemia 
of  nursing  mothers,  mammary  abscesses  or  boils,  carbuncles, 
chronic  bronchitis,  leucorrhoea,  early  decay  of  the  teeth  in 
children,  etc. 

CALX  CHLORATA— CHLORINATED  LIME. 
CHLORIDE    OF  LIME. 

Formula. — CaCl202CaCl2. 

Derivation. — Chloride  of  Lime  is  obtained  by  passing  chlor- 
ine over  hydrate  of  lime  till  saturation  is  effected.  It  is  in  the 
form  of  a  grayish-white  substance,  either  in  powder  or  friable 
masses,  dry  or  but  slightly  moist.  It  is  readily  soluble  in 
water,  and  will  absorb  moisture  when  exposed  to  the  air.  It 
has  a  bitter,  caustic  taste,  and  a  slight  odor  of  chlorine. 

Medical  Properties  and  Action. — Chloride  of  lime  is  a  stimu- 
lant, deodorizer,  disinfectant,  antiseptic  and  bleaching  agent. 
In  small  doses  it  increases  the  action  of  the  secreting  organs, 
and  if  long  continued  it  acts  specifically  upon  the  lymphatic 
glandular  system,  causing  the  reduction  or  absorption  of  glan- 
dular and  other  tumors.  In  large  doses  it  acts  as  an  acro- 
narcotic  poison,  and  its  use  should  always  be  commenced  in 
small  doses,  carefully  increased,  and  discontinued  when  such 
symptoms  as  nausea,  vomiting  or  giddiness  appear.  It  is 
chiefly  used  as  a  disinfectant. 

Therapeutic  Uses. — Solutions  of  chlorinated  lime  are  em- ' 
ployed  locally  in  scarlet  fever,  diphtheria,  aphthae,  gangrene  ; 
and   it  has  been  administered  internally  in  scrofula,  typhus, 
malignant  scarlet  fever,  syphilis,  etc. 

Dose. — Of  chloride  of  lime,  gr.  j  to  gr,  v,  in  solution,  sev- 
eral times  a  day.  As  a  wash,  i  part  dissolved  in  loo  parts  of 
water. 

Dental  Uses. — Chloride  of  lime  is  employed  in  dental  prac- 
tice in  the  treatment  of  cancrum  oris ;  one  method  of  applica- 
tion being  the  introduction  of  the  dry  powder,  with  the  pomt 
of  the  finger,  to  the  ulcerated  surface,  and  the  mouth  well 
washed  out  immediately  afterward ;  also,  in  the  form  of  a 
gargle  composed  of  l  part  of  powdered  chloride  of  lime  to  30 


272  DENTAL  MEDICINE. 


parts  of  mucilage  and  15  parts  of  syrup.  Solutions  of  chloride 
of  lime  arealso  efficient  in  scorbuticand  other  ulcerations  of  the 
mouth.  It  is  also  employed  to  correct  the  fetor  of  the  breath, 
in  the  form  of  a  mouth  wash,  prepared  as  a  weak  solution. 

One  of  the  most  important  uses  in  dental  practice  is  as  a 
bleaching  agent,  either  alone  or  in  combination  with  other 
substances,  to  restore  the  color  of  devitalized  teeth.  When 
chlorinated  lime  is  employed  for  bleaching  discolored  teeth,  a 
good  quality  should  be  obtained,  and  no  steel  instrument  used 
for  its  introduction ;  wood  or  gold  instruments  are  to  be  pre- 
ferred, and  the  chloride  should  be  perfectly  dry,  and  have  been 
kept  so  from  the  time  it  was  made.  An  efficient  bleaching 
preparation  is  composed  of  equal  parts  of  dry  chlorinated  lime 
and  tartaric  acid,  mixing  them  together  dry,  and  adding  a  little 
of  the  acid  at  a  time.  When  prepared,  the  mixture  should  be 
kept  in  a  glass-stoppered  bottle.  For  bleaching  purposes, 
chlorinated  lime  is  also  combined  with  chloroform,  in  the  form 
of  a  thin  paste.  When  chlorinated  lime,  or  its  combinations, 
is  introduced  into  the  cavity  of  a  tooth,  it  should  be  secured 
by  a  temporary  filling  of  gutta  percha,  Hill's  Stopping,  or  one 
of  the  zinc  preparations,  and  be  secured  from  passing  beyond 
the  foramen  of  the  root,  by  a  filling  introduced  near  the  apex 
of  the  root.  More  than  one  application  may  be  required,  after 
which  the  cavity  should  be  thoroughly  cleansed,  and  a  tem- 
porary fiiUing  of  the  whitest  shade  of  the  oxychloride  of  zinc 
filling  material  be  introduced  and  worn  for  some  time,  after 
which  a  more  durable  gold  filling  can  be  inserted. 

DENTAL   FORMUL.<E. 

For  Gangrene  of  the  Mouth — Cancrum  For  Fetor  of  the  Breath. 

Oris.  Bartholow. 

.„  R.     Calc.  chlorat  .    .    ,    ,   %'m 

Bartholow.  .         ,     .,  '4  ■• 

Aquae  destil    .    .    .    .  5  ij 

R .     Calc.  chlorat 5  ss  Alcoholis ^  ij 

Mucilaginis gss  01.  rosse gtt.iv.     M. 

Aqua  destil ^  iiiss.  M.       SiGNA. — A   teaspoonful  in  a  tumblerful 

SiGNA. — To  be  used  as  a  lotion.  of  water  ;  used  as  a  gargle. 


CAMPHO-PHENIQUE.  273 


CAMPHO-PHENIQUE. 

Formula. — CgHnO. 

Derivation. — A  limpid,  volatile  fluid  with  a  hot,  aromatic 
taste,  and  the  odor  of  camphor,  obtained  from  the  chemical 
union  of  carbolic  acid  and  camphor.  Dissolve  9  parts  of  the  acid 
in  one  part  of  alcohol  and  mix  with  25  parts  of  camphor, 
forming  a  clear  oily  solution. 

Medical  Properties  and  Therapeutic  Uses. —  Campho-phe- 
nique  is  an  antiseptic,  local  anaesthetic,  germicide  and  parasi- 
ticide. It  is  also  non-irritant,  non-poisonous,  insoluble  in 
water  or  glycerine,  does  not  discolor  or  stain,  and  possesses 
an  agreeable  odor  and  taste.  It  prevents  suppuration  in  fresh 
wounds,  controls  it  in  wounds  in  all  stages,  and  as  a  local  an- 
aesthetic obtunds  pain.  It  is  claimed  that  campho-phenique, 
pure,  is  equal  to  i  to  85  of  bichloride  of  mercury  which  is 
six  times  as  strong  as  it  can  be  used  even  on  the  unbroken 
skin,  and  about  25  times  as  strong  as  is  considered  safe  on 
cut  surfaces.  Campho-phenique  is  altogether  free  from  toxic 
or  caustic  properties,  and  is  one  of  the  safest  of  germicides  ; 
it  also  maintains  an  unchanged  integrity,  and  is  well  adapted 
to  a  large  proportion  of  pathological  dental  cases.  It  should 
never  be  combined  with  water  or  glycerin,  but  it  will  mix  in 
all  proportions  with  alcohol,  ether,  chloroform,  and  all  fatty 
substances. 

Employed  as  an  antiseptic,  it  penetrates  the  tissue  as  rap- 
idly as  carbolic  acid,  and  also  slightly  hardens  the  tissue. 

Dental  Uses. — As  a  pulp-canal  dressing,  campho-phenique 
has  given  very  satisfactory  results  as  a  substitute  for  corrosive 
sublimate,  carbolic  acid,  creosote,  oil  of  cloves,  iodoform,  etc. 
If  thoroughly  applied  to  the  gum  or  injected  with  a  hypoder- 
mic syringe,  it  acts  as  an  efficient  local  anaesthetic,  causes  no 
constitutional  disturbance.  It  is  also  employed  as  an  obtun- 
der  of  sensitive  dentine,  and  relieves  the  pain  following  the 
extraction  of  abscessed  teeth  when  applied  on  a  pledget  of 
cotton  :  it  also  relieves  the  pain  attending  the  separation  of 
teeth,  and  irritation  of  the  dental  pulp.  It  is  also  used  as  the 
18 


274  DENTAL   MEDICINE. 


menstruum  for  the  arsenic  and  morphia  of  pulp  devitahzing 
preparations  :  also  for  putrescent  pulps,  and  as  an  antiphlo- 
gistic in  the  earlier  stages  of  periodontitis.  It  will  mitigate 
the  pain  attending  the  induction  of  suppuration,  and  either  in 
full  strength  or  diluted,  give  satisfactory  results  when  injected 
into  fistulae.  It  is  also  useful  as  an  antiphlogistic  in  the  earlier 
stages  of  sthenic  pericementitis  applied  to  the  gum  on  small 
pads  of  linen  and  renewed.  Also  useful  in  eczema,  intolerable 
itchings,  burns,  sprains,  etc. 

For  Chapped  Hands. 
J.   W.   DOWNEY,   M.  D. 
U .     Campho-phenique. 

Oil  of  cade  . S.a  J  j 

Rose  cosmoline ^j     M. 

SiG. — Apply  frequently. 

To  Sterilize  Instruments. — For  the  purpose  of  sterilizing  or 
disinfecting  instruments,  such  as  broaches,  nerve-canal  instru- 
ments, etc.,  a  solution  of  campho-ph6nique,  or  of  eugenol,  or 
of  oil  of  cassia,  or  oil  of  turpentine,  or  of  terpinol  may  be 
kept  in  a  small  large-mouthed  bottle  into  which  the  instru- 
ment may  be  dipped  before  using.  Bichloride  of  mercury 
injures  steel  instruments.  Dr.  W.  D.  Miller  recommends  a 
boiling  solution  of  bicarbonate  of  sodium  as  the  most  effec- 
tive sterilizer  (see  Dr.  Miller's  experiments  in  sterilizing  den- 
tal instruments  in  the  chapter  on  Antiseptics  in  Dental  Prac- 
tice). 

CAMPHORA— CAMPHOR. 

Formula. — CioHjgO. 

Source. — Camphor  is  a  concrete  substance  obtained  from 
the  camphor  laurel,  an  evergreen  tree  of  China,  Japan  and 
Formosa,  by  sublimation,  the  crude  gum  being  purified  by 
resublimation  with  quicklime.  Refined  camphor  is  in  the 
form  of  large  circular  cakes,  one  or  two  inches  thick,  and  has 
a  strong,  penetrating,  fragrant  odor  and  a  bitter,  pungent  taste, 
attended  with  a  slight  sense  of  coolness.  It  is  white,  pellucid? 
and  somewhat  unctuous  to  the  touch. 

Medical  Properties  and  Action. — Camphor  is  anodyne,  stim- 


CAMPHOR.  275 


ulant,  refrigerant,  diuretic  and  diaphoretic.  It  increases  the 
action  of  the  heart  and  arteries,  and  renders  the  pulse  softer 
and  fuller ;  but  such  effects  are  very  transitory,  and  are  fol- 
lowed by  depression.  In  large,  but  not  over-doses,  it  allays 
pain  and  spasm,  and  induces  sleep.  In  over-doses,  it  excites 
narcotic  symptoms,  with  those  of  an  irritant  poison,  and  has 
proved  fatal.     It  acts  chiefly  on  the  nervous  system. 

Therapeutic  Uses. — Camphor  is  administered  in  fevers  of  an 
asthenic  type,  acute  inflammations,  inflammation  of  the  brain, 
delirium  tremens,  asthma,  rheumatic  and  nervous  headaches, 
diseases  of  the  heart,  hysteria,  dysentery,  diarrhoea,  cholera, 
etc,  etc.  Externally  as  an  anodyne  in  rheumatism,  and  as  a 
discutient  in  chronic  inflammatory  affections  ;  also,  the  powder 
as  a  snuff  in  coryzaand  influenza,  and  in  the  form  of  Camphor 
Liniment — Linimentum  CamphorcB — (camphor  i  part,  olive 
oil  4  parts). 

Camphor  Water — Aqua  Camphorcs — (camphor  gr.  cxx, 
alcohol  TTLxl,  carbonate  of  magnesia  Sss,  distilled  water  Oij). 

Soap  Liniment — LinunenUun  Saponis — (camphor  .5iv,  oil  of 
rosemary  f.^ss,  alcohol  Oij,  water  Svj)  is  an  anodyne  and 
gentle  rubefacient  for  sprains,  rheumatic  and  gouty  pains. 

Spirit  of  Camphor — Spiritus  Campliorcz — (camphor  oiv, 
alcohol  Oij). 

Dose. — Of  camphor  in  substance,  gr.  ij  to  gr.  x,  in  form  of 
an  emulsion,  made  of  sugar,  gum  arable,  myrrh  and  water. 
Of  camphor  water  5j  to  5j  ;  of  spirit  of  camphor,  lltv  to 
mxx. 

Dental  Uses. — In  dental  practice,  the  spirit  of  camphor  is 
locally  employed  to  allay  the  pain  arising  from  the  near  expo- 
sure of  the  pulps  of  teeth :  also  the  pain  of  sensitive  dentine, 
and  that  following  the  extraction  of  teeth  affected  with  peri- 
odontitis ;  also  to  arrest  the  hemorrhage  and  allay  the  pain  of 
wounded  pulps  of  teeth.  It  forms  an  efficient  anodyne  when 
in  the  form  of  a  strong  solution  of  camphor  in  chloroform. 
Camphor  has  also  been  employed  in  the  treatment  of  putres- 
cent pulps  of  teeth. 

Combined   with   creosote    or    carbolic    acid,    camphor    is 


276  DENTAL   MEDICINE. 


thought  to  have  the  power  of  modifying  the  escharotic  action 
of  these  agents.  For  such  a  purpose,  20  grains  of  camphor 
are  combined  with  i  ounce  of  the  creosote  or  carbohc  acid. 

The  Oil  of  Camphor — Oleum  Camphorce — is  preferred  by- 
some  to  answer  such  indications.  Camphor  also  forms  one 
of  the  ingredients  of  the  celluloid  base  of  artificial  teeth, 
which  is  composed  of  pyroxylin  100  parts,  camphor  40  parts, 
oxide  of  zinc  2  parts,  and  vermillion  0.6  part.  With  ether, 
camphor  is  also  used  as  a  local  anaesthetic.  A  cataplasm  of 
camphor,  morphia  and  flaxseed,  applied  to  the  cheek,  has 
been  used  for  the  relief  of  odontalgia. 

Phenol- Camphor — is  made  by  mixing  together  i  part  of 
carbolic  acid  and  3  parts  of  camphor.  After  24  hours  this 
becomes  a  liquid,  having  a  specific  gravity  of  990.  It  is  used 
with  oil  as  an  antiseptic,  and  in  the  form  of  spray  may  be 
applied  to  the  skin  as  a  local  anaesthetic.  It  is  also  employed  to 
disinfect  or  sterilize  surgical  and  dental  instruments,  and  on  wool 
and  gauze  for  dressing  wounds.  It  is  soluble  in  ether,  alcohol 
and  oils,  but  insoluble  in  water  or  glycerine.  Menthol,  cocaine, 
salicylic  acid,  iodoform,  chloral  hydrate  and  mercuric  chlo- 
ride are  solublein  phenol-camphor.  (See  Campho-Phenique.) 

Nausea  from  Impression  Taking. — Dr.  A.  W.  McCandless 
recommends  a  gargle  of  camphor  water.  Should  this  fail,  a 
four  per  cent,  solution  of  cocaine  painted  over  surface  of  the 
tongue  and  palate  will  produce  the  desired  result  except  in 
very  obstinate  cases. 

DENTAL   FORMULA. 

For  a  Local  AncBsthetic.  SiGNA. — Apply  with  camel's-hair  brush, 

R .     Pulv.  camphorse  .    .    .    .  ^  viij  allow  to  dry  and  reapply  as  freely  as 

^ther.  sulph    ....    f  5j.     M.  is  necessary  to  render  part  insensible 

SiGNA, — Applied   to  the  gum  over  the  to  pain. 

tooth  to  be   removed,  until   it   turns 

white  or  becomes  blanched. 

For  a  Stimulant  and  Anodyne  Lotion. 
For  a  Local  AncBsthetic. 

R.     Chloral,  R.     Spiritus  rosmarini    .    .     §j 

Camphorse  .    .  aa    .    .  5  Camphoras ^j 

Morphise  sulph    ...  3  ss  Saponis  albse  ....     5  iv.     M, 

Chloroformi     ....  3J.  M.       Signa.— To  be  applied  as  a  lotion. 


CAPSICUM.  277 


For  a  Local  AncBsthetic.  For  Neuralgia  and  Exposed  Pulps. 

R .     Camphorse 3J  R .    Camphorae 5  parts. 

.i^ther    vel  chloroformi     '^\).    M.  Chlor.  hydratis    ...     2  parts. 

SiGNA.— Apply     with    a    camel's-hair  Cocaine   hydrochlor    .     I  part.  M. 

brush.  SiGNA. — Heat  to  boiling  point  of  water, 

when  it  liquefies ;  use  as  a  local  ap- 
plication. 

'  For  Pain  of  Tooth  Extraction. 

R.     Camphorse,  ^      Camphor v^]. 

Chlor.  hydratis  aa  equal  parts.  M.  Chloroform     .    .    .    ,    f  jij.    M. 

SlGN.\. — Apply  as  a  lotion.  SiGNA. — Apply  on  cotton. 

CAMPHORA  MONOBROMATA— MONOBROMATED  CAMPHOR. 

Forimila. — CioH^BrOa. 

Derivation. — Monobromated  Camphor  is  obtained  by  the 
action  of  bromine  on  camphor,  and  subsequent  purification 
with  animal  charcoal  and  repeated  crystallization.  It  is  a 
colorless,  crystalline  substance,  with  the  odor  of  camphor  and 
turpentine,  and  a  slightly  bitter  taste.  It  is  insoluble  in  water, 
but  soluble  in  alcohol  and  ether. 

Medical  Properties  and  Action. — It  produces  a  sedative  effect 
upon  the  circulatory  system,  and  especially  upon  the  cerebro- 
spinal nervous  system,  and  is  also  an  antispasmodic. 

Therapeutic  Uses. — Bromide  of  camphor  is  employed  as  a 
sedative  and  antispasmodic,  in  affections  of  the  nervous  sys- 
tem, and  where  camphor  is  indicated,  as  in  asthma,  neuralgia, 
hysteria,  delirium  tremens,  etc. 

Dose. — Of  bromide  of  camphor,  gr,  ij  to  gr.  x,  for  an 
adult. 

Dental  Uses. — In  dental  practice,  the  bromide  of  camphor 
is  employed  as  a  sedative  in  convulsions  of  dentition,  neural- 
gia, etc.  For  children  suffering  from  the  convulsions  of  den- 
tition, gr.  j  of  the  bromide  of  camphor  in  acacia  mucilage, 
and  administered  every  hour,  has  been  very  serviceable  in  ar- 
resting the  paroxysms. 

CAPSICUM. 

CAYENNE    PEPPER. 

Source. — Capsicum  is  obtained  from  the  tropics  of  both 
hemispheres,   being   the    fruit   of  capsicum   annuum,  and  of 


278  DENTAL  MEDICINE. 


other  species  of  capsicum.  The  crimson  or  yellow  pods  are 
dried  and  ground  to  powder,  which  has  a  bright  red  color, 
and  an  aromatic  smell,  with  a  bitter,  acrid,  burning  taste.  Its 
acrid,  pungent  qualities  are  due  to  a  peculiar  substance  in  the 
form  of  a  thick,  yellowish-red  fluid,  called  capsicine. 

Medical  Properties  and  Action. — Capsicum  is  a  powerful 
stimulant,  producing,  when  small  doses  are  taken,  a  sensation 
of  warmth  in  the  stomach,  and  a  general  glow  over  the  body. 
It  promotes  the  digestive  process,  and  stimulates  the  circula- 
tion, and  also  the  genito-urinary  organs.  In  excessive  doses, 
capsicum  is  an  irritant  poison. 

Therapeutic  Uses. — It  is  employed  in  certain  forms  of  dys- 
pepsia, flatulent  colic,  scarlet  fever,  yellow  fever,  delirium 
tremens,  opium  habit,  etc.,  etc.  Externally  or  locally  as  a 
gargle,  in  putrid  or  other  forms  of  sore  throat,  chronic 
inflammation  of  the  fauces,  hoarseness  due  to  a  relaxed  con- 
dition of  the  vocal  cords,  relaxed  uvula,  and  in  poisoning 
by  opium,  belladonna  and  aconite,  it  has  proved  useful  as  a 
stimulant. 

Dose. — Of  powdered  capsicum,  gr.  v  to  gr.  x,  in  pill.  Of 
the  tincture  of  capsicum — Tinctiira  Capsici  (capsicum  oji  to 
diluted  alcohol  Oij) — the  dose  is  TTlx  to  f5j.  Of  the  infusion 
— Infusum  Capsici  (capsicum  Sss ;  boiling  water  Oj) — the  dose 
is  foss.     The  infusion  is  also  used  as  a  gargle. 

Dental  Uses. — In  dental  practice  the  tincture  of  capsicum  is 
serviceable  in  the  early  stages  of  acute  periodontitis ;  and 
also  where  it  is  necessary  to  hasten  suppuration  as  quickly 
as  possible,  on  account  of  the  increasing  severity  of  the 
attack — a  solution  composed  of  gtt.  xxv,  in  a  glass  of  warm 
water,  of  which  a  mouthful  is  to  be  retained  for  some 
minutes. 

The  tincture  of  capsicum  is  also  useful  in  chronic  dental 
periodontitis,  to  resolve  the  inflammatory  products.  It  is 
also  used  to  stimulate  the  gums  and  mucous  membrane  of  the 
mouth  in  chronic  inflammation  and  ulceration,  and  for  loose- 
ness of  the  teeth  as  a  result  of  salivation ;  also  in  cases  of 
turgidity  and  pufifiness  of  the  gums.    It  is  often  serviceable  in 


PURIFIED   ANIMAL   CHARCOAL.  279 

chronic  alveolar  abscess  as  an  injection,  after  the  sac  has  been 
destroyed,  also  in  recession  of  the  gums  from  the  necks  of  the 
teeth,  for  the  purpose  of  stimulating  them.  A  few  drops 
added  to  a  solution  of  aromatic  sulphuric  acid  will  prove 
serviceable  in  caries  of  the  maxillary  bones  and  in  disease  of 
the  antrum.  An  efficacious  stimulant  gargle  may  be  made  of 
the  tincture  of  capsicum  oss,  to  rose  water  Sviij.  Dr.  Kirk 
recommends  capsicum  as  a  local  stimulant  and  counter- 
irritant  in  the  initial  stages  of  pericemental  inflammation  be- 
fore the  formation  of  pus  has  taken  place  ;  in  cases  of  soreness 
about  roots  of  pulpless  teeth,  due  to  external  violence,  cold, 
etc.,  and  not  to  septic  irritation  ;  for  relief  of  severe  neuralgias 
following  the  extraction  of  lower  molar  teeth,  in  the  form  of  a 
cataplasm  applied  to  the  affected  side  of  the  face,  or  by  moist- 
ening a  piece  of  heavy  blotting  paper  and  applying  this  to  the 
side  of  face.  Dr.  J.  F.  Flagg  recommends  the  use  of  cap- 
sicum for  pericemental  inflammation  in  the  form  of  the 
powder  sewed  in  small  linen  bags  to  be  placed  in  the  mouth 
over  root  of  affected  tooth.  Dr.  Leffman  recommends  small 
oval  disks  cut  from  capsicum  plaster  (Seabury  &  Johnson's), 
the  surface  of  which  has  been  lightly  anointed  with  the 
ethereal  extract,  or  oleoresin  of  capsicum,  which  can  be  nicely 
adapted  to  the  gum. 

CARBO  ANIMALIS  PURIFICATUS— PURIFIED  ANIMAL 
CHARCOAL. 

Source. — Animal  Charcoal,  called  "bone  black,"  is  obtained 
by  exposing  bones  to  a  red  heat,  protected  from  the  air.  It 
consists  of  charcoal,  phosphate  and  carbonate  of  lime. 

Purified  Animal  Charcoal. — Carbo  Animalis  Purificatus — 
is  obtained  by  digesting  bone  black  in  hydrochloric  acid  and 
water  to  a  moderate  heat,  when  it  is  dried  and  heated  to  red- 
ness in  a  covered  crucible. 

Properties  and  Action. — Animal  charcoal  is  an  absorbent, 
and  is  used  to  counteract  the  effects  of  poisonous  agents,  such 
as  the  alkaloids  and  acids. 

Dose. — Of  animal  charcoal  as  an  absorbent,  5ss,  to  neutralize 


280  DENTAL   MEDICINE. 


the  effects  of  each  grain  of   such  agents  and  strychnia  and 
morphia.    - 

CARBO  LIGNI— WOOD  CHARCOAL. 

Source. — Wood  Charcoal  is  obtained  by  subjecting  soft 
wood  to  a  red  heat  with  but  a  Hmited  supply  of  air,  by 
which  the  water,  etc.,  are  removed,  allowing  the  carbon  to 
remain. 

Properties  and  Action. — Wood  charcoal  is  antiseptic  and  dis- 
infectant and  detergent,  and  is  very  serviceable  in  correcting 
the  fetor  of  discharges  and  arresting  the  process  of  ulceration, 
especially  when  in  the  form  of  the  dry  powder,  or  mixed  with 
linseed  as  a  poultice. 

Therapeutic  Uses. — For  foul  and  gangrenous  ulcers,  gan- 
grene, phagedaena,  suppurating  surfaces,  cancerous  tumors, 
etc.,  etc. 

Dental  Uses. — The  powdered  charcoal  added  to  water,  in 
the  proportion  of  one  or  two  drachms  to  a  glass  of  water,  forms 
an  efficient  disinfectant  gargle  for  the  offensive  fetor  of  mercu- 
rial stomatitis  ;  also  useful  in  foul  and  gangrenous  ulcers  of  the 
mouth,  diseased  gums,  offensive  ulcerations,  offensive  fetor  of 
cancrum  oris,  etc.,  etc.  Notwithstanding  its  detergent  prop- 
erties, injury  results  from  its  use  as  a  dentifrice,  on  account  of 
its  tendency  to  cause  recession  of  the  gums  from  the  necks  of 
the  teeth. 

CARVACROL. 

Source. — The  caraway  plant,  a  native  of  Europe. 

Derivation. — Carvacrol  is  a  product  of  the  essential  oil  of 
caraway,  which  is  obtained  from  the  seeds  of  the  plant. 
Caraway — carum — seeds  are  of  a  light  yellow  color,  with  a 
pleasant  aromatic  smell,  and  a  sweetish,  warm,  spicy  taste. 
They  are  stomachic  and  carminative,  and  are  occasionally  used 
in  flatulent  colic,  as  a  corrective  of  other  medicines.  The 
volatile  oil  of  caraway  is  most  employed  in  doses  of  gtt.  j  to 
gtt.  X.  Carvacrol  is  obtained  by  treating  the  oil  of  caraway 
with  iodine,  and  washing  the  product  with  potassa,  when  it  is 
mixed  with  carvene,  which  is  one  of  the  liquid  oils  of  caraway. 


CARVACROL.  281 


Carvacrol  is  also  found  among  the  products  of  the  action  of 
iodine  on  camphor.  When  pure,  it  is  a  colorless,  viscid  oil, 
lighter  than  water,  in  which  it  is  nearly  insoluble.  Its  odor 
is  like  that  of  creasote,  and  its  taste  is  persistent,  strong  and 
acrid. 

Medical  Properties  and  Action. — Carvacrol  is  antiseptic,  car- 
minative, disinfectant  and  escharotic.  Combined,  it  forms  an 
efficient  gargle  in  inflammatory  conditions.  It  is  not  employed 
internally. 

Dental  Uses. — In  dental  practice,  carvacrol  has  been  em- 
ployed as  a  substitute  for  creasote,  carbolic  acid,  and  glycerole 
of  thymol,  in  the  treatment  of  odontalgia,  sensitive  dentine, 
alveolar  abscess,  and  as  an  antiseptic  in  the  pulp  canals  of 
teeth  ;  also  as  a  gargle  in  inflamed  and  ulcerated  conditions 
of  the  mucous  membrane  of  the  mouth,  tonsillitis,  etc.  Com- 
bined with  water,  in  the  proportion  of  3  drops  to  the  ounce,  it 
forms  an  efficient  gargle  in  stomatitis,  tonsillitis,  etc. ;  the 
strength  of  the  solution  may  be  increased,  when  a  more  pow- 
erful action  is  required.  It  is  also  employed  with  advantage 
in  sensitive  cavities  of  the  teeth,  in  operating  with  the  dental 
engine,  to  lessen  the  pain  from  friction  of  the  instrument.  As 
an  application  in  odontalgia,  from  an  exposed  and  irritable 
pulp,  it  affords  almost  instantaneous  relief  It  is  claimed  for 
carvacrol,  that  it  is  not  so  liable  to  cause  inflammation  as  crea- 
sote ;  especially  when  it  is  applied  through  the  pulp  canals. 
When  employed  to  obtund  the  sensitiveness  of  dentine,  it  is 
necessary  to  confine  it  in  the  cavity  of  the  tooth  for  a  few  days, 
by  means  of  a  temporary  filling  of  zinc  preparation,  as  it 
readily  dissolves  Hill's  Stopping  and  gutta  percha.  When  it 
is  used  in  the  form  of  an  injection  in  alveolar  abscess,  a  sharp, 
burning  sensation  is  experienced  as  soon  as  it  reaches  the  seat 
of  the  affection,  when  the  crown  cavity  of  the  tooth  should  be 
immediately  closed. 

In  patients  of  a  scrofulous  diathesis,  it  is  necessary  to  exer- 
cise care  in  the  use  of  carvacrol.  When  applied  to  cavities 
before  the  introduction  of  the  filling,  and  to  exposed  pulps,  it 
is  introduced  on  a  pellet  of  cotton. 


282  DENTAL   MEDICINE. 


CRINOLINE  OR  QUINOLINE. 

Formula. — CgHgN. 

Derivation. — ChinoHne  was  first  obtained  from  coal  tar,  but 
afterward  from  the  cinchona  alkaloids.  More  recently  it  has 
been  produced  by  the  action  of  glycerin  on  aniline,  or  nitro- 
benzol.  It  is  an  oily  liquid,  with  highly  refracting  property, 
and  it  combines  with  acids  to  form  salts.  The  salt,  Tartrate 
of  ChinoHne,  is  not  so  deliquescent  as  the  other  salts  formed  by 
its  combination  with  acids,  and  is  in  the  form  of  lustrous 
crystals,  which  preserve  their  form  even  in  a  damp  atmosphere, 
although  they  are  soluble  in  water.  ChinoHne  is  very  soluble 
in  alcohol  and  sparingly  soluble  in  water. 

Medical  Properties  and  Action. — Chinoline,  like  other  phenol 
derivatives,  such  as  resorcin,  hydroquinone,  etc.,  possesses  the 
power  to  lower  fever  heat,  but  does  not  affect  the  normal 
temperature. 

Therapeutic  Uses. — Like  resorcin,  chinoline  has  been  used 
in  intermittent  and  remittent  fevers  with  great  success ;  also 
in  septic  disorders.  Topically,  chinoline  is  a  valuable  antisep- 
tic, and  successfully  acts  upon  minute  organisms,  preventing 
their  increase  and  septic  decomposition.  A  five  per  cent,  solu- 
tion of  the  tartrate  of  chinoline,  the  salt  generally  employed 
has  been  applied  locally  in  diphtheria,  with  marked  effect. 

Dose. — Of  chinoline,  gr.  v  to  xv. 

Dental  Uses. — Chinoline  is  used  in  dental  practice  as  an 
antiseptic,  belonging  to  the  same  class  as  resorcin,  the  salt 
tartrate  of  chinoline,  in  the  form  of  a  five  per  cent,  solution, 
being  preferable  for  local  application.  It  is  also  used  in  com- 
bination with  carbolic  acid,  for  application  on  cotton  to  an 
aching  cavity  from  which  a  tooth  has  been  extracted. 

CHLORIDE   OF   ALUMINIUM— ALUMINII  CHLORIDUM— 
CHLORALUM. 

The  chloride  of  aluminium,  also  known  as  Chloralum,  is  pre- 
pared by  passing  chlorine,  at  high  temperatures,  over  a  mix- 
ture of  aluminium  and  charcoal.  By  placing  the  anhydrous 
chloride  of  aluminium  in  water,  it  is  converted  into  hydrated 


METHYL   CHLORIDE.  283 


chloride.  It  is  said  to  be  quite  as  potent  as  chloride  of  zinc  or 
carboHc  acid,  and  devoid  of  poisonous  properties  and  unpleasant 
odor,  and  is  unirritating,  rendering  it  a  useful  antiseptic  and  dis- 
infectant. As  it  does  not  cauterize,  it  is  especially  convenient  for 
applications  to  the  mouth.  The  taste  is  sharply  saline,  like  that  of 
alum,  and  its  action  closely  approximates  that  of  chloride  of  zinc. 
In  dental  practice  it  has  been  used  in  the  treatment  of  peri- 
odontitis, alveolar  abscess,  caries  of  bones,  putrid  pulps,  alve- 
olar pyorrhoea,  and  other  diseases  of  mucous  membrane. 

CHLORIDE  OF  MAGNESIA— MAGNESH  CHLORIDUM, 

Chloride  of  Magnesia  is  prepared  by  evaporating  to  dryness 
a  concentrated  solution  of  muriate  of  magnesia,  the  chloride 
being  obtained  in  the  state  of  a  fused  hydrate.  It  is  a  bitter, 
very  deliquescent  salt,  which  acts  mildly  and  favorably  as  a 
purgative,  causing  a  flow  of  bile,  and  an  increase  of  appetite. 
On  account  of  its  extreme  deliquescence  the  liquid  form,  pre- 
pared by  dissolving  the  salt  in  its  weight  of  water,  is  preferred. 
The  dose,  diluted,  is  5ss  to  5j.  In  dental  practice  the  chloride 
and  hypochlorite  of  magnesia  have  been  employed  for  bleach- 
ing teeth. 

CHLORIDE  OF  TIN— STANNUM  CHLORIDUM. 
Chloride  of  tin  is  prepared  by  heating  tin  and  hydrochloric 
acid  together,  and  has  been  recommended  for  local  application 
in  purulent  discharges.  According  to  M.  Mallez,  chloride  of 
tin  has  a  direct  action  upon  purulent  secretions  from  mucous 
surfaces,  without  any  substitutive  action,  like  nitrate  of  silver 
for  instance.  Placed  in  contact  with  pus  globules,  under  the 
microscope,  these  are  seen  to  immediately  disappear.  In  puru- 
lent diseases  of  the  eye,  also,  it  was  successful.  A  solution 
consisting  of  5ss  of  the  salt  in  fSiij  of  distilled  water,  is  used 
for  injections. 

CHLORIDE   OF  METHYL— METHYL  CHLORIDE. 
Formula  — CH3CI. 

Derivation. — Chloride  of  Methyl  is  produced  by  the  action 
of  chlorine  upon  marsh  gas ;   by  heating  together  common 


284  DENTAL   MEDICINE. 


salt,  sulphuric  acid  and  methyl  alcohol ;  or  it  is  more  cheaply- 
manufactured  by  using  the  waste  products  of  beets  used  in 
the  manufacture  of  sugar.  It  is  the  chloride  of  a  hydrocar- 
bon in  the  form  of  methyl  chloride,  and  resembles  ether  in 
appearance,  taste  and  smell,  but  is  less  inflammable.  Chlo- 
ride of  Methyl  is  generally  employed  as  a  local  anaesthetic  in 
the  form  of  spray,  although  it  possesses  general  anaesthetic 
properties  also,  and  being  very  volatile  and  ether-like,  rapid 
evaporation  occurs  when  it  is  applied  over  an  affected  area. 
To  avoid  producing  inflammation  of  the  skin,  or  an  erythema 
in  persons  having  an  irritable  skin,  caution  is  necessary ;  and 
it  should  be  applied  over  as  many  nerve  filaments  as  possible. 
The  special  advantage  of  chloride  of  methyl  is  its  external 
application,  which  may  never  cause  more  than  a  temporary 
irritation  of  the  skin.  In  order  to  produce  local  anaesthesia 
with  this  agent,  M.  Bardet  proposes  before  spraying  a  surface 
with  it,  to  paint  it  with  glycerine,  the  revulsive  action  being 
less  severe,  and  the  glycerine  forming  a  surface  on  which  the 
drops  of  the  refrigerant  mixture  collect,  and  which  may  be 
readily  removed  after  the  desired  effect  has  been  produced ; 
the  use  of  glycerine  is  also  said  to  prevent  the  dangers  of 
sloughing.  Dr.  Ch.  Bailly  recommends  the  following  method 
of  applying  this  agent  as  a  local  anaesthetic  :  A  tampon  of  dry 
cotton  covered  with  dry  silk  is  sprayed  with  the  anaesthetic 
until  its  temperature  is  reduced  to  23°-55°C.  below  zero. 
The  tampon  is  then  grasped  with  ebony  pincers  and  applied 
for  a  few  seconds  to  the  parts  to  be  anaesthetized,  and  perfect 
abolition  of  pain  at  once  secured.  Drs.  Daboll  and  Rhein 
recommend  chloride  of  methyl  as  an  application  for  trigemi- 
nal neuralgia,  giving  immediate  relief  by  paralyzing  the  small 
filaments  of  the  nerve.  The  spray  is  also  used  for  obtunding 
sensitive  dentine ;  it  produces  a  more  intense  cold  than  ether, 
and  with  less  pain,  its  obtunding  effect  lasting  a  longer  time. 

CHLORAL. 
CHLORAL  HYDRAS HYDRATE  OF  CHLORAL. 

Formula. — CgH  CI3O  HgO . 

Derivation. — Chloral   is   obtained   by   the    action    of    dry 


CHLORAL.  28o 

chlorine  gas  on  absolute  alcohol,  and  is  purified  by  sulphuric 
acid  and  a  small  quantity  of  lime ;  a  small  quantity  of  water 
converts  it  into  solid  crystalline  hydrate  of  chloral.  It  is  in 
the  form  of  a  snow-white,  crystalline  mass,  with  a  pungent 
odor  and  taste,  soluble  in  its  own  weight  of  distilled  water, 
and  very  soluble  in  alcohol.  When  heated,  it  fuses  and 
evaporates,  leaving  no  residue,  and  in  the  air  without  com- 
bustion. 

Medical  Properties  and  Action. — Hydrate  of  chloral  is  hyp- 
notic and  anaesthetic,  possessing  more  of  the  former  and  less 
of  the  latter  property  than  chloroform,  and,  unlike  chloroform, 
after  its  administration  there  is  no  elimination  by  the  breath 
or  urine.  It  diffuses  into  the  blood  rapidly,  causing  an  abun- 
dant flow  of  saliva,  and  a  cooling  sensation  in  the  stomach, 
followed  by  warmth.  Very  large  quantities  cause  a  high 
degree  of  gastric  irritation,  nausea  and  vomiting.  Taken  in 
moderate  quantity  it  stimulates  the  appetite,  and  produces 
muscular  relaxation.  It  is  uniformly  certain  in  its  action  as  a 
hypnotic,  has  no  depressing  influence,  and  does  not  cause 
constipation.  Administered  in  doses  of  gr.  x  to  gr.  xxx,  it 
causes  unconsciousness  to  pain,  and  a  profound  sleep,  lasting 
over  several  hours.  The  sleep  it  produces  is  quiet  and  gentle, 
and  induced  without  distress.  Liebreich  claims  to  have  pro- 
duced sleep  which  lasted  from  five  to  fifteen  hours,  with  from 
25  to  30  grains  of  hydrate  of  chloral. 

The  habitual  use  of  chloral  leads  to  a  disorder  which  is 
somewhat  similar  to  the  "opium  habit,"  although  it  may  not 
be  as  persistent.  When  there  is  present  no  susceptibility  to 
its  hypnotic  action,  it  is  liable  to  cause  headache,  and  in  some 
cases,  a  delirious  excitement.  Its  hypnotic  action  is  immedi- 
ately preceded  by  a  stage  of  excitement,  generally  of  short 
duration,  which  is  followed  by  sudden  and  complete  sleep, 
very  much  like  natural  sleep,  calm,  dreamless  and  refreshing. 
It  differs  from  a  condition  of  narcotism  from  the  fact  that  the 
patient  can  be  easily  roused  to  partake  of  nourishment,  and 
will  readily  fall  asleep  again. 

There  are  no  unpleasant  after-effects  resulting  from  a  mod- 


286  DENTAL   MEDICINE. 


erate  dose  of  chloral,  dififering  in  this  respect  from  morphine, 
which  often  causes  headache,  faintness,  giddiness,  nausea  and 
constipation.  Chloral  is  not  capable  of  producing  insensibility 
to  pain,  unless  the  quantity  administered  is  sufficient  to  sus> 
pend  the  functions  of  the  cerebrum.  Great  care  is  necessary 
in  its  use  where  symptoms  of  pulmonary  disease,  fatty  heart 
or  degenerated  blood-vessels  are  apparent. 

When  a  proper  dose  is  administered  the  pupil  contracts 
slightly,  but  the  pulse  may  remain  unaltered  or  become 
slower,  and  the  respiration  unaffected.  When  an  improper  or 
dangerous  dose  is  taken,  profound  narcotism  ensues,  the 
respiration  becomes  slower,  the  pulse  weak,  rapid  and  irregu- 
lar, sensibility  is  lost,  all  reflex  movements  are  impossible,  and 
complete  muscular  relaxation  follows.  It  destroys  life  by  the 
suspension  of  the  functions  of  the  cerebrum,  and  by  paralysis 
of  the  respiratory  centre,  and  of  the  cardiac  ganglia ;  also 
death  may  suddenly  follow  by  paralysis  of  the  heart,  in  cases 
of  fatty  degeneration,  and  the  lower  lobes  of  the  brain  remain 
unaffected.  The  paralytic  phenomena  caused  by  chloral  are 
due  to  its  direct  action  on  the  nervous  centres.  The  con- 
gestion of  the  meninges  of  the  brain  and  cord,  and  distention 
of  the  right  cavities  of  the  heart,  have  been  observed  after 
poisoning  by  chloral.  The  antidote  in  cases  of  poisoning  is 
strychnia,  and  the  same  treatment  as  in  opium  poisoning. 

Therapeutic  Uses. — The  most  important  uses  of  chloral  are 
in  diseases  of  the  nervous  system,  such  as  delirium  tremens, 
insanity,  tetanus,  acute  mania,  neuralgia,  chorea,  whooping 
cough,  and  in  rheumatism,  cholera  morbus,  sea-sickness,  etc., 
etc.  Having  no  direct  pain-relieving  power,  except  by  sus- 
pending the  functions  of  the  cerebrum  and  in  dangerous  doses, 
sleep  can  be  procured  and  pain  relieved  by  combining  the 
chloral  with  morphine,  when  it  is  very  effective. 

Dose. — Of  hydrate  of  chloral,  gr.  v  to  3j ;  but  it  must  be 
remembered  that  one  half  drachm  has  produced  poisonous 
symptoms.  Thirty  grains  of  hydrate  of  chloral  are  equal  in 
effect  to  gr.  j  of  opium.  For  adults,  if  short  intervals  of  sleep 
are  required,  from  gr.  xx  to  xxx  will  answer;    for  young 


CHLORAL.  287 

children,  gr.  vij  is  the  dose  recommended.  Moderate  and 
frequently  repeated  doses  are  better  than  a  single  large  one. 

Dental  Uses. — In  dental  practice,  the  hydrate  of  chloral,  in 
the  form  of  from  gr.  ss  to  gr.  j,  is  applied  to  inflamed  pulps  for 
the  relief  of  odontalgia,  and  is  an  efficient  remedy ;  it  is  also 
employed  for  the  relief  of  neuralgia  of  the  fifth  pair  of  nerves  ; 
as  a  stimulant  and  deodorizing  application  to  foul  and  fetid 
indolent  ulcers ;  also  as  a  local  anaesthetic,  for  this  purpose 
being  combined  with  camphor  and  other  agents  (see  Aconite), 
(see  Camphor) ;  also  as  an  anodyne,  for  the  relief  of  the  pain 
of  periodontitis ;  and  as  an  injection,  for  alveolar  abscesses. 
It  is  also  used  as  a  lotion  (when  diluted  with  water)  for  in- 
flammations of  the  oral  mucous  membrane,  and  as  an  anti- 
septic (chloral,  5j ;  aqua,  f5ij)  for  injecting  putrid  pulp-canals 
and  chronic  alveolar  abscesses.  Although  it  is  employed 
hypodermically,  yet  painful  phlegmons  have  resulted  from  its 
repeated  application. 

Oiloral  Phenol. — When  chloral  is  combined  with  carbolic 
acid  it  liquefies,  and  a  preparation  composed  of  equal  parts  of 
phenol  and  chloral  is  used  for  odontalgia  as  well  as  for  its 
antiseptic  qualities.  Chloral  Phenol  is  a  colorless,  clear  liquid, 
soluble  in  alcohol,  acetic  acid,  amyl-alcohol,  chloroform,  carbon, 
glycerin  and  ether.  It  possesses  the  odor  and  taste  of  its 
constituents. 

Chloral  has  the  property,  when  rubbed  with  certain  bodies, 
such  as  camphor,  of  forming  therewith  syrup  liquids.  With 
phenol  (absolute  carbolic  acid)  it  also  liquefies,  and  a  prepara- 
tion composed  of  equal  parts  of  phenol  and  chloral  is  used  in 
medicine  for  allaying  toothache,  as  well  as  for  its  antiseptic 
properties.  A  recent  study  by  Fabini,  says  the  Chemist  and 
Druggist,  shows  that  chloral-phenol  possesses  the  odor  and 
taste  of  its  constituents,  and  when  applied  to  the  skin  produces 
inflammation  and  an  eruption  of  small  blisters.  It  is  a  colorless 
and  clear  liquid,  having  a  sp.  gr.  at  20°  C.  of  1.289,  ^^  that  it 
sinks  in  anhydrous  glycerin.  It  is  soluble  in  alcohol,  acetic 
acid,  amyl-alcohol,  chloroform,  carbon  bisulphide,  and  glycerin, 
as  well  as  in  ether  when  slightly  warmed.     It  is  only  partially 


288  DENTAL   MEDICINE. 


soluble  in  petroleum  ether,  and  benzine  only  dissolves  a  little 
of  the  fluid,  and  what  is  dissolved  is  chloral  phenol.  Fabini 
tested  the  fluid  thoroughly,  with  a  view  to  determining  whether 
it  is  a  mechanical  mixture,  and  it  behaved  in  every  way  towards 
re-agents  as  carbolic  acid  does,  while  with  sulphuric  acid  some 
of  the  chloral-phenol  yielded,  after  twenty-four  hours,  a  velvet- 
colored  plaster-like  mass,  which  consisted  of  meta-chloral  and 
phenol-sulphonic  acid.  There  seems  to  be  no  doubt,  therefore, 
that  chloral-phenol  is  a  mixture. 

This  preparation  should  not  be  confounded  with  the 
phenol  camphor  devised  by  Cockrane  (not  campho-phenique)> 
and  made  by  mixing  together  i  part  of  carbolic  acid  and  3 
parts  of  camphor.  After  twenty-four  hours  this  becomes  a 
liquid,  having  a  sp,  gr.  of  .990.  It  is  used  with  oil  as  an  anti- 
septic. As  a  spray  it  may  be  applied  to  the  skin  to  produce 
local  anaesthesia.  It  may  be  employed  for  disinfecting  surgical 
instruments,  and  upon  wool  and  gauze  for  wound  dressing. 
It  is  soluble  in  alcohol,  ether  and  oils,  but  not  in  water  or 
glycerin.  Menthol,  cocaine,  salicylic  acid,  iodoform,  chloral 
hydrate,  and  mercuric  chloride  are  soluble  in  phenol  camphor. 

DENTAL    FORMULAE. 

For  Foul  and  Fetid  Indolent  Ulcers.  For  Foul  and  Fetid  Indolent  Ulcers. 

R .     Chloral  hydratis  .    .    .  gr.x  R .     Chloral  hydratis  .    .    .  5  ss 

Aquae  destillatae  .    .    .  f ^j.        M.  Adipis §j.         M, 

SiGNA. — To  be  applied  as  a  lotion.  SiGNA. — To  be  used  as  aa  ointment. 


For  a  Local  Ancssthetic. 


Local  AncBsthetic. 
Dr.  Storie. 


R.     Chloral  hydratis  .    .    .  gij  r^.^      ^^.A    ,■ 

■n  1      •  T,  T"         HT  Ix-     Chloral  hydratis. 

rulvens  camphorse ,    .  3  ij.        M.  ^  •' 

c,        .      ^-     I,  T  J  -u.     J  Camphors  (gum)  .  equal  parts. 

SiGNA, —  io  be  applied  as  an  obtund-  ^  v&       /       1       r 

.  ^        ,  r  1-  Rub  well  in  a  mortar  to   liquefaction 

mg  mixture,  by  means  01  an  appuca-  .       ^ 

and  add  gtt.v  of  carbolic  acid, 
tor.  ^ 

For  a  Hypnotic. 

R ,     Chloral  hydratis  .    .    .  3  ij 
Syrupi  aurantii  flores  .  3  iv 
R .     Chloral  hydratis  .    .    .  3  iij  Syrupi  tolutani     .    ,    .  3  iv 

Aquse  destill    .    .    .    .  f  gj.        M.  Aquae  destillatae  .    .    .  ^vj.       M. 

SiGNA. — Apply  on  cotton.  Signa. — Dose  ]/(,  part,  largely  diluted. 


For  Odontalgia — Pulpitis. 
Flagg. 


CHLORALAMID— CHLORALAMIDE.  289 

For  Neuralgia.  SiGNA. — Apply  with  camel's-hair  brush ; 

R .     Chloral  hydratis,  .  partes  3  dry  rapidly,  and  reapply. 

Camphor;^     .    .    .  partem  I.      M. 

SiGNA.— To    be  applied    over   seat   of  For  Neuralgia  and  Exposed  Pulps. 

pain.  R .     Chloral  hydratis      .    .  2  parts 

For  a  Local  Ancssiketic.  Camphorse  ....       5  parts 

B.     Chloral  hydratis,  Cocaini  hydrochloratis  I  part.     M. 

Pulveris  camphors  .aa  .  gij  ^eat  to  about  boiling  point  of  water 

Morphine  sulph     .    .    ,  ^ss  till  liquefied. 

Chloroformi ^].     M.  SiGNA. — Apply  locally. 


CHLORALAMIDE.    CHLORALAMID. 
OH 


Formula. — CCUCH 


NH.CHO 

Derivation. — Formed  by  the  combination  of  two  parts  of 
chloral  hydrate  and  one  part  of  formamide. 

Medical  Properties  arid  Action. — Chloralamide  has  been  used 
with  good  results  in  hysteria,  chorea,  acute  mania,  monomania, 
typhoid  fever,  senility,  neurasthenia,  insomnia,  phthisis,  and 
diseases  not  attended  by  much  pain.  Mupfenbach,  from  a 
number  of  trials,  regards  it  a  useful  hypnotic,  but  with  the 
disadvantage  that  its  certainty  of  action  can  never  be  relied 
upon.  No  bad  effects  upon  the  circulation  or  in  the  feelings 
of  the  patients  have  been  observed  by  Reichmann,  although 
vomiting  may  occur.  According  to  Langaard,  this  drug  pro- 
duced a  decided  reduction  of  blood-pressure,  which  is  devel- 
oped more  gradually  and  is  later  in  making  its  appearance 
than  that  caused  by  chloral.  Compared  with  chloral,  chloral- 
amid  is  more  agreeable  to  the  taste,  and  more  easily  admin- 
istered, rarely  causes  digestive  disorders,  does  not  depress  the 
heart  or  the  circulation,  seldom  produces  cerebral  disturbances. 
Compared  with  sulfonal,  it  is  more  prompt  in  its  action, 
more  soluble,  more  easily  administered,  the  sleep  it  produces 
always  passes  away  by  morning,  and  it  is  less  expensive. 

The  action  of  chloralamide  upon  digestion  is  as  follows: 

1.  Large  quantities  retarded  the  digestion  of  fibrin  in  the 
ratio  of  the  quantity  employed. 

2.  Small  quantities,  for  example,  up  to  0.02  gramme,  did 

19 


290  DENTAL   MEDICINE. 


not  have  any  marked  influence  either  in  accelerating  or  in  de- 
laying the  digestion  of  fibrin. 

3.  Putrefaction  was  not  retarded  by  either  large  or  small 
quantities. 

Therapeutic  Uses. — The  most  important  uses  of  chloralamid 
are  in  diseases  of  the  nervous  system  not  attended  by  much 
pain,  such  as  have  before  been  enumerated. 

Dose. — Of  chloralamid,  gr.  30  to  45.  In  doses  of  twenty  to 
thirty  grains,  it  produces  better  effects  than  sulphonal,  but 
caution  in  the  use  of  this  drug  is  necessary  in  diseases  of 
the  heart,  on  account  of  its  causing  decided  reduction  of  blood- 
pressure. 

For  Use  as  a  Hypnotic. 

^.     Chloralamid ^iv 

Spts.  vini  gallici ^  ij 

Curacao 5ij.    M. 

S. — A  tablespoonful  (30  grains  chloralamid)  in  water  and  repeated 
in  foiir  hours  if  necessary. 

CHLORINIUM— CHLORINE. 

Derivation. — Chlorine  is  a  greenish-colored  gas,  of  a  pene- 
trating and  suffocating  odor,  very  persistent  and  characteristic. 
It  is  soluble  in  water,  in  the  proportion  of  two  volumes  of  the 
gas  to  one  of  water,  and  is  a  supporter  of  combustion.  It  is 
generated  from  black  oxide  of  manganese,  hydrochloric  acid 
and  water,  is  an  active  irritant,  and,  when  breathed,  excites 
cough,  a  sense  of  suffocation  and  irritation  of  the  mucous 
membrane  of  the  nostrils  and  bronchial  tubes,  and,  when  con- 
siderable quantities  are  inhaled,  it  induces  spitting  of  blood, 
violent  pains,  and  sometimes  death.  It  is  a  deodorizer  and 
disinfectant,  and  has  been  used  to  destroy  disease  germs  and 
offensive  effluvia. 

Chlorine  Water. — Aqua  Chlori — is  an  aqueous  solution 
of  chlorine,  formed  by  passing  the  gas  through  water.  It  is 
a  greenish-yellow  liquid,  with  an  astringent  taste  and  the 
suffocating  odor  of  chlorine  gas.  It  should  be  kept  in  glass- 
stoppered  bottles,  in  a  cool  place,  and  protected  from  the  light. 

Therapeutic    Uses. — Chlorine   water   is    used   internally  in 


CHLOROFORM.  291 


malignant  fevers,  such  as  scarlet  fever,  typhus,  and  in  diph- 
theria, aphthse,  gangrene,  syphilis,  diseases  of  the  liver,  skin 
diseases,  etc. ;  and  as  an  antidote  for  hydrocyanic  acid.  The 
poisonous  effects  of  chlorine  gas  may  be  prevented  by  am- 
moniacal  gas.  Albumen  is  the  antidote  for  chlorine  water, 
given  freely,  in  the  form  of  milk,  flour,  eggs,  etc. 

Dose. — Of  chlorine  water,  f5j  to  f5iv,  diluted. 

Dental  Uses, — Chlorine  water  is  employed  in  dental  prac- 
tice as  a  local  application  in  gangrene  of  the  mouth  and 
fauces,  aphthae,  cancrum  oris,  and  fetor  of  the  breath.  Chlorine 
gas  has  been  employed  to  bleach  discolored  teeth,  care  being 
taken  that  it  reaches  no  other  part  than  the  cavity  of  the  tooth 
undergoing  such  treatment,  which  may  be  accomplished  by 
the  application  of  a  large  rubber  dam,  such  as  is  used  in  the 
operation  of  filling  teeth. 

DENTAL    FORMULA. 

For  Aphtha  and  Gangrene  of  the  Mouth.  For  Aphthes,  Stomatitis,  and  Cancrum 

B .     Aquae  chlori ^  ss  Oris. 

Aquae  destillatie    .    •    -  5  iiiss  R .     Liquoris  chlori 

Syrupi  simp ^ss.     M.  Mellis   .    .    .   aa   .    .    .  |  ij.      M. 

SiGNA.— To  be  used  as  a  gargle  or  lo-  SiGNA. — To  be  applied  as  a  lotion. 


For  Mercurial  Stomatitis. 


tion. 

.For  Fetor  of  the  Breath  and  an  Anti- 
septic. R .     Liquoris  chlori  .    .    .  part  j 
R.     Liquoris  chlori   .    .    .    .   ^iv  Aquae  destillatse    .    .  parts  viij.  M, 

Mellis 3  iv  Signa. — To  be  used  as  a  gargle  for  cor- 

Aquae  destillatae    .    .    .   ^  x.     M.  recting    the    fetor,   and   diminishing 

SiGNA. — To  be  applied  as  a  gargle.  slightly  the  discharge. 

CHLOROFORMUM— CHLOROFORM. 

Formula. — CHCI3.     Sp.gr.  1.480. 

Derivation. — Chloroform  is  obtained  by  the  distillation  of 
alcohol  with  chlorinated  lime.  The  form  for  medicinal  use 
{Chloroformiim  Piirificatiini)  is  purified  by  agitation  with  sul- 
phuric acid,  which  frees  the  crude  chloroform  from  such  dele- 
terious agents  as  chlorinated  pyrogenous  oil;  the  lighter  liquid 
is  then  separated,  and  carbonate  of  sodium,  previously  dis- 
solved in  water,  is  added  to  it.  The  mixture  is  then  agitated, 
the  chloroform  separated  from  the  supernatant  layer,  alcohol 


292  DENTAL   MEDICINE. 


mixed  with  it,  and  lime  in  coarse  powder  added.  It  is  a  color- 
less, volatile  liquid,  of  an  agreeable  ethereal  odor,  and  a  hot, 
aromatic,  sweet  taste.  It  is  slightly  soluble  in  water,  and  dis- 
solves very  readily  in  alcohol  and  ether  in  all  proportions.  The 
boiling  point  is  142°  F.  The  purest  form  of  chloroform  has 
a  specific  gravity  of  1.5022,  while  the  officinal  contains  a  little 
alcohol ;  it  is  a  terchloride  of  formyl.  The  purest  chloroform 
for  internal  use  is  obtained  from  the  hydrate  of  chloral.  The 
purity  of  chloroform  may  be  ascertained  by  agitating  it  with 
the  binitro-sulphuret  of  iron,  which  shows  the  presence  of 
alcohol  by  the  production  of  a  brown  tint ;  chlorinated  pyro- 
genous  oil  may  be  detected  and  removed  by  strong  sulphuric 
acid,  which  gives  the  solution  a  yellowish  or  reddish-brown 
color,  if  such  an  impurity  is  present. 

Medical  Properties  and  Action. — Chloroform,  when  inhaled, 
is  an  anaesthetic ;  and  when  administered  internally,  is  ano- 
dyne and  antispasmodic.  Its  effects  on  the  system  are  similar 
to  those  of  ether,  but  more  powerful  and  more  rapidly  pro- 
duced, and  it  requires  more  care  in  its  administration,  both  in- 
ternally and  by  inhalation  of  the  vapor.  Undiluted,  it  excites 
great  irritation  and  inflammation  of  the  mucous  membrane, 
and  the  vapor,  passing  through  the  fauces  in  quantity,  may 
enter  the  larynx  and  cause  great  heat,  inflammation  and  even 
oedema.  When  taken  internally  it  causes  a  feeling  of  warmth 
in  the  stomach,  followed  by  coldness,  similar  to  ether,  and  if 
taken  in  large  quantity,  undiluted,  it  acts  as  an  irritant  poison, 
inducing  violent  gastritis.  It  is  diffused  into  the  blood,  and 
affects  remote  parts.  It  increases  the  action  of  the  circula- 
tory system,  producing  excitement  of  the  brain,  followed  by  a 
deep,  heavy  sleep ;  and  in  poisonous  doses,  stupor  and  insen- 
sibility. The  first  effect  of  the  inhalation  of  the  vapor  of 
chloroform  is  a  feeling  of  warmth  and  excitement  extending 
to  the  extremities,  which  is  succeeded  by  noises  in  the  ears 
and  a  vibratory  thrilling  and  benumbing  sensation  throughout 
the  body,  followed  by  a  loss  of  feeling,  motion  and  conscious- 
ness, with  general  paralysis  of  the  respiratory  muscles,  ster- 
torous breathing,  quick  pulse,  which   may  become  irregular 


CHLOROFORM. 


293 


and  weak,  owing  to  the  sedative  action  on  the  heart.  The 
pupils,  at  first  contracted,  become  dilated,  and  there  is  com- 
plete relaxation  of  the  muscular  system. 

The  following  are  the  practical  conclusions  of  the  second 
Hyderabad  Commission :  "  The  recumbent  position  on  the 
back  and  absolute  freedom  of  respiration  are  essential.  If 
during  an  operation  this  position  cannot  be  from  any  cause 
maintained  during  the  administration  of  chloroform,  the  ut- 
most attention  to  the  respiration  is  necessary  to  prevent  as- 
phyxia or  an  overdose.  If  there  is  any  doubt  about  the  state 
of  respiration,  the  patient  should  be  at  once  restored  to  the 
recumbent  position  on  the  back.  To  insure  absolute  freedom 
of  respiration,  tight  clothing  of  every  kind,  either  on  the  neck, 
chest,  or  abdomen,  is  to  be  strictly  avoided  ;  and  no  assistants 
or  bystanders  should  be  allowed  to  exert  pressure  on  any 
part  of  the  patient's  thorax  or  abdomen,  even  though  the  pa- 
tient be  struggling  violently.  If  struggling  does  occur,  it  is 
always  possible  to  hold  the  patient  down  by  the  shoulders, 
pelvis,  or  legs,  without  doing  anything  that  can  possibly  inter- 
fere with  the  free  movements  of  respiration.  An  apparatus  is 
not  essential,  and  should  not  be  used,  as,  being  made  to  fit 
the  face,  it  must  tend  to  produce  a  certain  amount  of  asphyxia, 
and  take  up  part  of  the  attention  required  elsewhere.  How- 
ever it  is  made,  it  introduces  an  element  of  danger  into  the 
administration.  A  convenient  form  of  inhaler  is  an  open  cone 
or  cap  with  a  little  absorbent  cotton  inside  at  the  apex.  At 
the  commencement  of  inhalation  care  should  be  taken  by  not 
holding  the  cap  very  close  over  the  mouth  and  nose,  to  avoid 
exciting,  struggling  or  holding  the  breath.  If  struggling  or 
holding  the  breath  does  occur,  great  care  is  necessary  to  avoid 
an  over-dose  during  the  deep  inspirations  which  follow.  When 
quiet  breathing  ensues,  as  the  patient  begins  to  go  over,  there 
is  no  reason  why  the  inhaler  should  not  be  applied  close  to 
the  face ;  and  all  that  is  then  necessary  is  to  watch  the  cornea 
and  see  that  the  respiration  is  not  interfered  with. 

In   children,  crying  ensures  free  admission  of  chloroform 
into  the  lungs;    but  as  the  struggling  and  holding  the  breath 


294  DENTAL  MEDICINE. 


can  hardly  be  avoided,  and  one  or  two  whiffs  of  chloroform 
may  be  sufficient  to  produce  complete  insensibility.  They 
should  always  be  allowed  to  inhale  a  little  fresh  air  during 
the  first  deep  inspirations  which  follow. 

In  struggling  persons,  but  especially  in  children,  it  is  es- 
sential to  remove  the  inhaler  after  the  first  or  second  deep 
inspiration,  as  enough  chloroform  may  have  been  inhaled 
to  produce  deep  anaesthesia;  and  this  may  only  appear,  or 
may  deepen,  after  the  chloroform  is  stopped.  Struggling  is 
best  avoided  in  adults  by  making  them  blow  out  hard  after 
each  inspiration  during  the  inhalation.  The  patient  is,  as  a 
rule,  anaesthetized  and  ready  for  the  operation  to  be  com- 
menced when  unconscious  winking  is  no  longer  produced 
by  touching  the  surface  of  the  eye  with  the  tip  of  the  finger. 

The  anaesthesia  should  never,  under  any  circumstances,  be 
pushed  until  respiration  stops ;  but  when  once  the  cornea  is 
insensitive,  the  patient  should  be  kept  gently  under  by  occa- 
sional inhalations,  and  not  be  allowed  to  come  out  and  renew 
the  stage  of  struggling  and  resistance. 

As  a  rule  no  operation  should  be  commenced  till  the  patient 
is  fully  under  the  influence  of  the  anaesthetic,  so  as  to  avoid  all 
chances  of  death  from  surgical  shock  or  fright.  The  admin- 
istrator should  be  guided  as  to  the  effect  entirely  by  the  res- 
piration ;  and  his  only  object,  while  producing  anaesthesia,  is 
to  see  that  the  respiration  is  not  interfered  with.  If  possible 
the  patient's  chest  and  abdomen  should  be  exposed  during 
chloroform  inhalation,  so  that  the  respiratory  movements  can 
be  seen  by  the  administrator.  If  any  thing  interferes  with  the 
respiration  in  any  way,  however  slightly,  even  if  this  occurs 
at  the  commencement  of  the  administration,  if  breath  is  held, 
or  if  there  is  stertor,  the  inhalation  should  be  stopped  till  the 
breathing  is  natural  again.  This  may  sometimes  create  de- 
lay and  inconvenience,  but  experience  will  make  any  admin- 
istrator so  familiar  with  the  respiratory  functions  under  chlo- 
roform, that  he  will  in  a  short  time  know  almost  by  intuition 
whether  anything  is  going  wrong,  and  be  able  to  put  it  right 
without  delay,  before  any  danger  arises.     If  the  breathing  be- 


CHLOROFORM.  295 


comes  embarrassed,  the  lower  jaw  should  be  pulled  or  pushed 
from  behind  the  angles,  forward,  so  that  the  lower  teeth  pro- 
trude in  front  of  the  upper.  This  raises  the  epiglottis  and 
frees  the  larynx.  At  the  same  time  it  is  well  to  assist  the 
respiration  artificially  till  the  embarrassment  passes  off.  If 
by  any  accident  the  respiration  stops,  artificial  respiration 
should  be  commenced  at  once,  while  an  assistant  lowers  the 
head  and  draws  forward  the  tongue  with  catch  forceps,  by 
Howard's  method,  assisted  by  compression  and  relaxation  of 
the  thoracic  walls.  Artificial  respiration  should  be  continued 
till  there  is  no  doubt  whatever  that  natural  respiration  is  com- 
pletely re-established.  A  small  dose  of  morphia  may  be  in- 
jected subcutaneously  before  chloroform  inhalation,  as  it  helps 
to  keep  the  patient  in  a  state  of  anaesthesia  in  prolonged 
operation.  There  is  nothing  to  show  that  atropine  does 
any  good  in  connection  with  the  administration  of  chlo- 
roform, and  it  may  do  much  harm.  Alcohol  may  be  given 
with  much  advantage  before  operations  under  chloroform, 
provided  it  does  not  cause  excitement,  and  merely  has  the 
effect  of  giving  a  patient  confidence  and  steadying  the  circu- 
lation. And  it  is  the  opinion  of  the  Commission  that  "if  the 
above  rules  be  followed,  chloroform  may  be  given  in  any  case 
requiring  an  operation,  with  perfect  ease  and  absolute  safety, 
so  as  to  do  good  without  the  risk  of  evil." 

[As  the  physiological  actions  and  mode  of  administration 
of  chloroform  and  ether  are  similar,  the  reader  is  referred  to 
the  article  on  Sulphuric  Ether.] 

Therapeutic  Uses. — Besides  its  use  as  a  general  anaesthetic 
agent,  chloroform  is  internally  administered  in  substance,  as 
an  anodyne  and  antispasmodic,  for  non-inflammatory  affec- 
tions, such  as  nausea  and  vomiting,  sea-sickness,  sick  head- 
ache, flatulent  colic,  intermittent  fevers,  and  in  cholera,  for 
which  it  is  very  efficient.  The  vapor  is  employed  for  the  re- 
lief of  hay  asthma,  whooping  cough,  spasmodic  asthma,  and 
as  a  hypnotic  in  delirium  tremens,  and  as  an  injection  and 
lotion  in  neuralgia,  and  as  a  counter-irritant  or  vesicant,  for 
which  purposes  it  is  applied  to  the  skin,  and  evaporation  pre- 


296  DENTAL  MEDICINE. 


vented.  Great  care  is  necessary  in  the  administration  of 
chloroform  in  substance,  as  fatal  effects  have  followed  such 
use;  15  drops  have  destroyed  life.  Externally,  chloroform  is 
employed  as  a  stimulating  application  to  foul  and  indolent 
ulcers. 

Dr.  Spark  recommends  highly,  as  a  haemostatic  agent,  a 
solution  composed  of  chloroform  2  parts,  water  100  parts.  He 
claims  that  it  acts  with  a  rapidity  that  is  truly  marvelous,  and 
it  has  not  the  slightest  disagreeable  taste.  It  is  useful  in  all 
operations  upon  the  mouth  and  throat. 

Dose. — Of  chloroform,  Tltj  to  v,  in  sweetened  water  or  mu- 
cilage.    Dose  of  chloroform  for  inhalation,  5j  to  5ij. 

Spirit  of  Chloroform — Spiritus  Chloroforrni — is  composed 
of  chloroform  ^j ;  diluted  alcohol  5ij.  Dose  of  spirit  of  chlo- 
roform, 5ss  to  5j. 

Mixed  Chloroform-Morphia  Narcosis. — A  method  prac- 
ticed by  Prof.  Thiersch,  of  Leipsic,  succeeds  often  in  inducing 
a  perfect  analgesia  without  unconsciousness.  Morphine  is 
first  hypodermically  injected,  and  in  from  five  to  seven  min- 
utes afterwards  the  patient  is  very  lightly  chloroformed  till 
near  the  stage  of  excitement ;  the  operation  is  performed ;  as 
soon  as  pain  is  felt,  if  the  operation  is  a  prolonged  one,  a  little 
chloroform  is  added.  In  this  manner  not  the  tenth  part  of 
chloroform  is  needed,  and  it  is  claimed  that  the  operation  is 
as  painless  as  under  full  chloroform  narcosis,  and  there  is  no 
risk  of  danger  incurred.  Men  receive  one-half  a  grain  of 
morphine,  women  one-quarter  of  a  grain,  children  one-twelfth 
to  one-eighth  of  a  grain. 

Cocaine-Chloroform  Narcosis. — This  consists  essentially 
in  the  combined  use  of  cocaine  and  chloroform,  and  is  strongly 
favored  by  Prof.  Obolinski,  of  Cracow,  who  injects  either  be- 
fore or  after  the  anaesthesia  is  obtained,  from  one  to  three  cen- 
tigrammes of  cocaine ;  or  he  injects  in  the  neighborhood  o 
the  seat  of  the  operation,  and  during  its  progress,  from  three 
to  seven  centigrammes.  Cocaine  is  used  on  the  ground  that 
it  is  a  complete  antagonist  of  chloroform  and  chloral ;  but  it  is 
not  so  regarded  by  others,  who  represent  it  to  be  a  general  ex- 


CHLOROFORM. 


297 


citor  of  the  central  nervous  gray  matter,  rather  than  a  direct 
and  powerful  stimulator  of  the  heart,  while  its  stimulant  effect 
upon  respiration  is  not  to.be  depended  upon.  Prof  Obolin- 
ski  claims  that  this  mixed  narcosis  secures  anaesthesia  with 
the  use  of  less  chloroform,  and  that  vomiting  is  prevented, 
and  there  are  fewer  disagreeable  after-effects. 

Dental  Uses. — Chloroform  is  employed  in  dental  practice  as 
a  general  anaesthetic,  also  as  a  local  anaesthetic,  for  which  pur- 
pose it  is  generally  combined  with  other  agents ;  as  an  ano- 
dyne and  antispasmodic,  either  locally  applied  or  the  vapor 
inhaled,  as  in  the  treatment  of  convulsions  of  dentition,  for 
which  it  is  a  very  efficient  remedy. 


DENTAL 

For  Neuralgic  Affections. 
R .     Chloroformi, 

Spinti  ammonise, 
Tincturae  aconiti  aa  f  ^  j 
Olei  ricini  .    .    .    .  ^ij 
Linimenti  saponis  .   fjj.  M. 

SiGNA. — To  be  applied  as  a  liniment 
over  seat  of  pain. 

For  a  Local  Ancesthetic. 
R .     Chloroformi  purificati, 
Tincturse  aconiti, 
Alcoholis  .    .  aa  .    .  f  ^  j 
Morphinse    sulphat  .  gr.vj.  M. 

SiGNA. — To   be    applied   to  gum  over 
root  of  tooth  to  be  extracted. 

For  a  Local  Anaesthetic. 

Von  Bonhorst. 
R.     Chloroformi, 
.i^itheris  sulph., 
Spiriti  lavandulae, 
Pyrethri  (fluid  ext.)  .  aa  f  ^  j.  M. 
SlGNA. — Apply  for  one  or  two  minutes 
to  gum  over  root  of  tooth  to  be  ex- 
tracted. 

For  Odontalgia — Pulpitis. 
R.     Chloroformi  .    .    .    .   .^  ij 
Alcoholis Jj 


FORMULAE. 

/Ether 

§ss 

Camphorae  (pulv)  . 

.|ss 

Tinct.  opii    .    .    .    . 

|ss 

Oleum  caryophylli    . 

3J.          M. 

SiGNA. — Apply  on  cotton 

wool,  to  ex- 

posed  pulp. 

For  Neuralgic   Affections  of  the   Teeth. 

R .     Chloroformi  .    .    .    .  f  ^  j  or  ij 

Aquae Oj.  M. 

SiGNA. — To   be   used   as  a  wash  or  a 
gargle. 


Camphora;    .    .    .    .   5  iss 

M. 

SiGNA. — To   be   applied  as  a  liniment 
over  seat  of  pain. 


For  Neuralgic 

Affections. 

Chloroformi  .    . 

•    •  .5iJ 

Camphora;    .    . 

.    .   5  iss 

Olei  olivEe    .    . 

•    •  3'J- 

R. 


For  ( 

Odontalgia 

— Pulpitis. 

Chloroformi, 

Tinct. 

aconiti  .  aa  . 

f.^i'j 

Tinct. 

capsici  . 

.    . 

f5J 

Tinct. 

pyrethri 

Oleum 

I  caryoph  . 

aa 

.  f  5  ss 

Camphorae    (puh 

'■) 

•  5SS. 

M. 


SioNA. — Apply  on  cotton  wool. 


298  DENTAL   MEDICINE. 


R.     Chloroformi    ...  12 

parts, 

Tinct.  aconiti    .    .12 

Tinct.  capsici    .    .    4 

Tinct.  pyrethri  .    ,    2 

Olei    caryophilli    .     2 

Camphorae     ...     2 

Dissolve   the    camphor   in 

the   chloro- 

form,  then  add  the  oil  of  cloves,  then 

the  tinctures. 

For  an  Anodyne  Application   in  Neu-       For  excessive  vomiting  and  irritability 
~yalgia.  du7ing  Infantile  Diarrhoea. 

R .     Chloroformi  .    .    .    .  f  5  j  ^^-  >'•  ^\  "^«^^^- 

T  •  •        i-  1,        r  2  ••         -KK        R.     Spt.  chloroformi  .    .    .   ?  i 

Lmimenti  camphorae  f^ij.M,^^         ^  t)J 

Creasote W  ij 

SiGNA. — To  be   applied    over   seat   of  ,j.      .  ^^ 

^^    .  .  Vm.  ipecac tllv 

pain,  and  covered  with  oiled  silk,  to  .  .  .  i  rr  ••       ,, 

^  Aqu3e  anisi  .    .    q.  s  ad  5  ij,       M. 

prevent  evaporation.  SiGNA.-A  teaspoonfiil  in  a  little  water 

„      _         ,      J.  r^     ,.,.  for  a  child  one  year  old. 

For  Earache  of  Dentition.  •' 

Local  Ancesthetic. 

R.     Chloroformi.    .    .   .  ^j  Dr.  Parson. 

Olei  olivse ^  j  M. 

SiGNA. — Pour  from  gtt.  x  to  xx  in  ear, 
and  close  orifice  with  cotton. 

For  a  Local  AticBsthetic. 

R.     Chloroformi  ....  part,  xx 

Acidi  acetici  (cryst.)  part.  j.       M. 
SiGNA. — Apply  with  camel's-hair  brush, 
or  by  applicator. 

CREOLIN— CREOLINE 

Creolin  is  a  product  of  the  decomposition  of  coal  tar. 

Derivation. — It  is  obtained  from  English  pit-coal  by  distilla- 
tion, and  is  in  the  form  of  a  brownish,  syrupy  liquid,  complex 
and  very  impure,  with  an  odor  like  tar  ;  and  in  its  impure  state 
is  slightly  irritating,  slightly  caustic  and  strongly  acid,  and 
resembles  in  its  properties  the  phenols.  A  purified  preparation 
of  creolin  is,  however,  as  neutral  as  vaseline,  and  quite  as  in- 
offensive to  man  and  animals.  It  is  insoluble  in  water,  but 
soluble  in  ether,  chloroform,  and  absolute  alcohol. 

Therapeutic  Uses  and  Medical  Properties. — Creolin  is  both 
antiseptic,  germicide  and  haemostatic,  being  employed  for  the 
latter  purpose  in  obstetrical  practice ;  it  is  also  employed  in 
tonsillitis.  It  is  employed  with  great  benefit  in  ulers  of  the 
cornea.  Its  germicidal  powers  are  said  to  be  ten  times 
superior  to  those  of  carbolic  acid,  and  its  action  on  the  spores 
is  even  more  pronounced  than  corrosive  sublimate.  The  addi- 
tion of  from  eight  to  ten  drops  of  a  three  per  cent,  aqueous 
solution  is  sufficient  to  completely  sterilize  and  prevent  the 
development  of  the  comma-bacillus,  and  from  one  to  three 


CREOLINE.  299 


drops  of  a  one  per  cent,  solution  will  retard  the  development 
of  the  micro-organisms,  and  four  drops  will  prevent  it  com- 
pletely. Its  antiseptic  properties  are  said  to  be  superior  to  all 
other  drugs  at  our  command.  It  is  soluble  in  water,  alcohol 
and  glycerine,  and  it  does  not  affect  the  skin  nor  corrode  in- 
struments, and  the  odor  of  the  purified  preparation  is  not  dis- 
agreeable. It  appears  to  have  an  anodyne  effect,  and  is  cura- 
tive when  applied  to  open  wounds.  Creolin  has  also  been  em- 
ployed in  antral  disease.  An  aqueous  solution  of  creolin  is 
made  of:  3^.  Creolin,  gr.  iss ;  aquae  destil.,  TTLcl,  which  may 
be  applied  with  a  brush  or  in  the  form  of  spray.  For  dental 
use  it  may  be  injected,  or  applied  on  floss-silk  or  cotton  wool. 
Creolin  is  considered  to  be  a  good  deodorizer  of  iodoform. 
One  or  two  drops  of  creolin  may  be  added  to  half  a  glass  of 
water  for  a  mouth-wash,  to  correct  disagreeable  odors  from 
the  teeth  and  mouth.  It  will  also  hold  in  check  acid-produc- 
ing germs  ;  it  is  also  recommended  for  its  action  on  mucous 
surfaces  in  soft  and  congested  mouths,  and  to  correct  acid 
conditions,  and  the  treatment  of  fistulous  tracts  of  suppurat- 
ing surfaces ;  also  in  root  canals  to  deodorize  dead  tissue. 
It  will  also  remove  the  rust  on  instruments  when  applied  by 
means  of  a  felt  wheel  of  a  lathe.  To  sterilize  instruments  a 
two  per  cent,  solution  may  be  used;  also  on  the  hands,  and  a 
one  per  cent,  solution  for  irrigation  of  wounds  and  treatment 
of  mucous  surfaces. 

DENTAL  FORMULAE. 
For  Alveolar  Pyorrhoea. 
Dr.  a.  W.  Harlan. 

B .     Creolin 3  j 

Sodium  fluo.  silicate gr.  xx 

Olei    Cassiae TTl  xx 

Glycerinse S'v.       M, 

Dilute  with  water  to  suit. 
SiGNA. — Use  as  a  mouth-wash  on  a  soft  brush,  during  the  intervals  between  sit- 
tings when  escharotic  and  antiseptic  agents  have  been  applied. 


300  DENTAL  MEDICINE. 


CINCHONA  FLAVA— YELLOW  CINCHONA. 
CALISAYA   BARK,  PERUVIAN    BARK. 

Source. — Cinchona  is  the  bark  of  the  tree  cinchona  calisaya, 
which  grows  on  the  western  coast  of  South  America,  espe- 
cially of  Bolivia  and  Southern  Peru.  Different  varieties  are 
named,  according  to  their  color,  as  Cinchona  Flava,  yellow 
cinchona ;  Cinchona  Pallida,  pale  cinchona ;  Cincliona  Rubra, 
red  cinchona.  The  medical  properties  of  these  barks  depend 
upon  the  alkaloids  they  contain  in  varying  proportions,  Quin- 
ifia  being  the  most  important. 

Medical  Properties  and  Action. — The  yellow  bark  has  a 
much  more  bitter  taste  than  the  others,  but  is  comparatively 
free  from  acidity.  It  is  brownish  yellow,  the  powder  being  of 
an  orange  color,  and  it  contains  more  of  the  alkaloid  quinine 
than  the  other  barks. 

Cinchona  is  tonic,  astringent  and  antiperiodic,  and  the 
different  varieties  owe  their  tonic  and  antiperiodic  properties 
to  the  alkaloids  quinina,  cinchonina  and  cinchonidina.  On 
account  of  the  large  quantity  of  the  powdered  barks  it  is 
necessary  to  take  in  order  to  obtain  the  full  effects,  and  which 
cause,  in  some  cases,  derangement  of  the  stomach,  vomiting, 
headache  and  constipation,  the  alkaloid  quinine,  in  the  form 
of  sulphate  of  quinina,  is  preferable. 

Sulphate  of  Quinina — Quini?icB  Sidphas,  is  prepared  by 
boiling  the  yellow  bark  in  water  acidulated  with  hydrochloric 
acid,  by  which  the  alkaloid  is  separated  from  its  combination 
with  kinic  and  other  acids,  to  form  a  soluble  hydrochlorate. 
This  salt  is  decomposed,  and  the  quinine  is  precipitated  by  the 
addition  of  lime,  and  afterwards  washed  in  boiling  alcohol. 

Sulphate  of  quinine  is  in  the  form  of  colorless,  very  light 
and  silky  crystals,  and  is  readily  soluble  in  alcohol,  and  in 
water  acidulated  with  sulphuric  acid.  It  is  insoluble  in  ether, 
and  requires  740  parts  of  cold,  or  30  parts  of  boiling  water 
to  entirely  dissolve  it. 

Cinchona  is  also  antiseptic,  as  the  powder  dusted  over 
unhealthy  wounds  will  arrest  putrefaction,  and  promote  healthy 


YELLOW   CINCHONA.  30I 


cicatrization.  Quinina  will  destroy  minute  organisms,  and 
preserve  substances  from  decomposition.  The  cinchona  alka- 
loids are  readily  diffused  into  the  blood,  and  when  hypodermi- 
cally  injected,  are  absorbed  by  the  blood.  Cinchona  and  its 
alkaloids  increase  the  action  of  the  heart  slightly,  but  in  large 
doses  quinine  depresses  the  heart's  action  and  enfeebles  the 
pulse.  As  quinine  accumulates  in  the  brain,  a  sense  of  fullness 
in  the  head,  a  tightness  and  constriction  about  the  forehead,  a 
ringing  in  the  ears  {tinnitus  auriuin),  giddiness  and  vertigo  are 
experienced.  Deafness  also  occurs,  as  the  effect  of  consider- 
able doses,  and,  if  continued,  permanent  injury  may  result. 
Poisonous  doses  cause  intense  headache,  dilated  pupils,  de- 
lirium, coma  and  convulsions. 

Peruvian  bark  and  its  alkaloids  are  the  most  reliable  tonics 
and  antiperiodics. 

Tlierapentic  Uses. — Cinchona,  and  its  alkaloid,  quinine,  are 
internally  employed  in  the  treatment  of  intermittent  fevers, 
and  also  other  fevers,  such  as  remittent,  typhus,  puerperal  and 
scarlet;  also  in  influenza,  neuralgias  of  a  malarial  origin,  acute 
rheumatism,  phthisis,  advanced  stages  of  pneumonia  and  pleu- 
risy, erysipelas,  urticaria,  diseases  of  the  eye,  epilepsy,  gangrene 
and  mortification,  scurvy,  pyaemia,  malarial  dysentery,  passive 
hemorrhages,  and  as  an  anthelmintic,  etc.,  etc. 

Dose. — Of  powdered  cinchona,  3j  to  5iij,  given  in  infusion 
of  liquorice;  of  the  extract  of  cinchona,  gr.  j  to  gr.  x,  in  pill; 
of  sulphate  of  quinine,  gr.  j  to  3j. 

Dental  Uses. — Cinchona  and  its  alkaloid,  quinine,  are  em- 
ployed in  dental  practice,  in  the  treatment  of  neuralgia  of  the 
fifth  pair  of  nerves,  when  due  to  malaria,  in  from  five  to  ten 
grain  doses  of  quinine;  in  aphthous  ulcerations,  in  one  or  two 
grain  doses  every  two  or  three  hours,  especially  when  there  is 
great  debility ;  and  in  cancrum  oris  ;  also  in  the  form  of  gargles 
and  lotions,  in  gangrenous  ulcerations  of  the  mouth.  Cinchona 
is  also  employed  in  the  form  of  powder,  as  an  ingredient  of 
certain  dentifrices,  for  its  tonic  and  antiseptic  properties. 


302 


DENTAL   MEDICINE. 


DENTAL    FORMULA. 


B. 


B. 


B 


Dentifrice, 
Pulv.  cinchonas  flav  .    .   ^iv 
Pulv.  saponis  cas.  albi  .  ^  iv 

CretK  prep ^  ij 

Magnesia  calc ^iij 

Otto  rosse    ,,..,.  gtt.  viij 
Olei  caryophylli  .    .    .  gtt.  vj.     M. 


Dentifrice. 

Pulv.  cinchonee  flav.  . 

Cretse  prep 

Sacchari  albi  .... 
Pulv,  cinnamom  ,  .    . 
Pulv.  saponis  cas,  albi. 
Pulv.  myrrliae  .  .    .    , 


3J- 


M. 


For  Mercurial  Stomatitis. 
Garrettson. 


Tinct.  cinchonse 
Potassce  chloratis 
Sodae  bibor     .    . 
Aluminis  pulv.    . 
Potassse  permanganatis 
Aquse  coloniae    .    , 
Tinct.  myrrhae    .    . 
Tinct.  capsici      .    . 
Tinct.  kramerise     . 

Aquse 

SiGNA. — Use  as  a  gargle 


Jss 

gr.xxv 
I) 

Si 

§i 

^viij. 


Dentifrice. 
R .    Pulv.  cinchonse  flav   .    ,  Ib.ss 

Cretse  prep Ib.ss 

Pulv,  myrrhse      .    .    .    .  §iv 
Pulv.  radicis  iridis      .    .  ^  iv.    M. 

For  Ulceration  of  Gums. 
R,    Pulv.  cinchonse  .    .    .    .  jij 

Cupri  sulph gr.x 

Acacise  (pulv.)    .    .    .    .  ^j 

Mellis ^ij 

Aquse  purse giij.    M. 

SiG. — Apply  with  a  camel's-hair  brush 
to  ulcerated  surface  of  mucous  mem- 
brane. 

For  a  Wash  after  the  Extraction  of  Teeth. 

R,    Cinchonse  (decoct.)    ,    .  f^ij 

Aluminse jij 

Infus,  rosse f^ij.    M. 

SiGNA, — Use  as  a  gargle. 

For  Digestive  Stimulation  in  Pyorrhcea 
Alveolaris. 

Dr.  Chas.  B.  Atkinson. 
R.     Cinchonidinse  sulph.  .  ^ss; 

Acid,  sulph.  arom  .    .  §  ij ; 

Alcohol,  95  per  cent.    ^  iij ; 
M.  Aquse  dest.  q.  s.  ad.  .  ^  xv.      M. 

S. — One  teaspoonful  ter  die. 


CINNAMOMUM— CINNAMON, 


CASSIA    BARK, 


Source. — The  best  variety  of  cinnamon  is  obtained  from 
Ceylon,  and  is  the  prepared  bark  of  a  tree  of  the  natural  order 
Laurace(E. 

It  is  in  the  form  of  long,  cylindrical  pieces,  thin,  smooth, 
and  of  a  yellow-brown  color,  with  a  fragrant  odor,  and  a  warm, 
sweetish,  aromatic  and  slightly  astringent  taste.  It  contains  a 
volatile  oil,  a  slight  amount  of  tannic  acid,  an  acid  peculiar  to 
itself,  cinnamic  acid,  mucilage,  lignin,  etc. 


CINNAMON.  303 


Medical  Properties  and  Action.  Cinnamon  is  an  aromatic 
stimulant  and  astringent,  being  more  powerful  as  a  local  than 
as  a  general  stimulant.  Its  medicinal  virtues  principally  reside 
in  a  volatile  oil,  oleum  cinnamomi. 

TJierapeiitic  Uses. — Cinnamon  is  chiefly  used  as  an  adjunct 
to  other  medicines,  being  seldom  prescribed  alone,  though  it 
is  capable  of  allaying  nausea  and  vomiting,  and  also  relieving 
flatulence.  Combined  with  chalk  and  with  other  astringents, 
it  is  well  adapted  for  the  treatment  of  diarrhoea. 

Dose. — Of  cinnamon,  gr.  x  to  5ss  of  the  powder ;  of  the 
tincture,  the  dose  is  f5j  to  foiij. 

Oil  of  Cinnamon — Olctun  Cinnamomi — is  obtained  by  dis- 
tillation, and  when  fresh,  is  of  a  light  yellow  color,  which 
becomes  deeper  by  age,  and  ultimately  red.  It  has  an  exces- 
sively hot,  pungent  taste.  It  is  often  employed  to  conceal  the 
taste  of  other  medicines,  and  is  a  powerful  local  stimulant. 
Large  doses  of  the  oil  of  cinnamon  are  poisonous,  producing 
an  inflamed  and  corroded  condition  of  the  gastric  and  intesti- 
nal mucous  membrane. 

Dose. — Of  the  oil  of  cinnamon,  gtt.  j  or  gtt.  ij,  administered 
in  the  form  of  an  emulsion. 

Oil  of  Cassia. — The  oil  of  cassia  is  prepared  from  the  bud, 
and  the  oil  of  cinnamon  from  the  bark  of  the  same  order  of 
tree  LaiiracecB.  The  oil  of  cassia  is  preferred  by  many  to  the 
oil  of  cinnamon.  (See  Essential  Oils,  also  Antiseptics  in 
Dental  Practice). 

Cinnamon  water — Aqua  Ci7i7iamomi — (cinnamon,  carbonate 
of  magnesia  and  distilled  water),  is  used  as  a  vehicle  for  other 
medicines. 

Spirit  of  cinnamon — Spiritus  Cinnamojni — (oil  of  cinnamon, 
I  part,  stronger  alcohol  15  parts).     Dose,  gtt.  x  to  gtt.  xx. 

Dental  Uses. — Cinnamon,  in  the  form  of  powder,  is  cm- 
ployed  as  an  ingredient  of  dentifrices,  for  its  stimulant, 
astringent  and  aromatic  properties.  Oil  of  cinnamon  is  em- 
ployed as  an  ingredient  of  dentifrices,  for  its  stimulant,  astrin- 
gent and  aromatic  properties.  Oil  of  cinnamon  is  employed 
in    dental    practice    for   the    relief  of  odontalgia.     One  drop 


304  DENTAL  MEDICINE. 


applied  to  an  inflamed  dental  pulp  will  afford  temporary 
relief;  it  is,-  also,  combined  with  iodoform,  in  the  treatment  of 
alveolar  pyorrhoea. 

COCAINE. 

Source. — Cocaine  is  the  alkaloid  obtained  from  the  leaves 
of  the  Erythroxylon  Coca,  a  shrub  indigenous  to  certain  parts 
of  South  America,  as  Peru  and  Chili.  The  leaves  resemble 
those  of  Chinese  tea,  and  in  the  preparation  of  the  alkaloid  it 
is  necessary  that  they  should  be  of  the  best  quality,  which 
depends  upon  their  being  gathered  at  a  proper  time,  carefully 
dried  and  not  injured  by  age  or  by  exposure  to  the  air,  as 
moisture  deprives  them  of  all  value.  Cocaine  being  extremely 
susceptible  to  the  influence  of  acids,  A.  Castaing,  Ph.G.,  de- 
vised a  method  by  which  one  grain  of  cocaine  can  be  extracted 
from  four  hundred  and  eighty  grains  of  the  leaves  without 
using  acidulated  fluids,  which  is  as  follows  :  "  On  one  part  by 
weight  of  coca  leaves  pour  eight  parts  of  boiling  water,  and 
let  them  steep  for  half  an  hour  in  a  closed  vessel,  in  a  water 
bath ;  pour  the  whole  into  a  percolator,  and  when  all  the 
liquid  part  is  strained  off,  continue  the  exhaustion  of  the 
leaves  by  pouring  on  them  eight  parts  of  alcohol,  at  85°  ;  mix 
the  two  liquids  and  precipitate  them  by  means  of  acetate  of 
lead;  draw  off  with  a  siphon,  and  then  add  sulphate  of  sodium 
to  remove  the  salts  of  lead ;  filter  and  evaporate,  at  a  gentle 
heat,  until  the  liquid  has  attained  the  consistence  of  syrup ; 
treat  the  whole  with  water,  to  separate  the  resinous  part,  and 
then  precipitate  with  carbonate  of  sodium ;  the  precipitate  is 
then  to  be  exhausted  by  sulphuric  ether,  and  the  ethereal 
solution,  after  the  ether  is  distilled,  is  exposed  to  the  air  until 
every  trace  of  ether  has  completely  disappeared ;  by  this 
means  is  obtained  a  crystallized  residue,  of  a  brownish-yellow 
color,  and  of  a  disagreeable  smell.  This  is  impure  cocaine. 
The  coloring  matter  is  removed  by  washing  once  or  twice 
with  cold  alcohol.  The  cocaine  thus  purified,  appears  in  the 
form  of  transparent  prisms,  without  smell,  bitter  to  the  taste, 
soluble  in  seven  hundred  parts  of  cold  water,  more  soluble  in 
alcohol,  and  entirely  soluble  in  ether.     The  solution  has  an 


COCAINE.  305 

alkaline  reaction,  and,  when  applied  to  the  tongue,  it  imparts 
a  bitter  taste,  and  a  certain  insensibility,  followed  by  a  slight 
sensation  of  cold,  recalling  the  effect  of  ether  spray  upon  the 
epidermis.  Heated  to  208°  F.,  the  cocaine  becomes  liquid, 
and  under  the  influence  of  cold,  it  becomes  a  transparent 
mass,  which  gradually  assumes  a  crystalline  form.  If  it  be 
exposed  to  a  higher  heat  than  208°  F.,  cocaine  changes  its 
color  and  decomposes.  It  is  inflammable,  and  burns  with  a 
brilliant  flame,  leaving  an  ash.  It  forms  soluble  salts  with 
acids  (its  hydrochlorate  is  one  of  the  best),  and  all  these  salts 
are  more  bitter  than  the  alkaloid.  It  is  a  compound  of 
carbon,  hydrogen,  nitrogen  and  oxygen.  Pure  cocaine  is  in 
the  form  of  colorless,  transparent  prisms,  without  odor,  but 
with  a  slight  bitter  taste.  The  chemical  composition  of  the 
alkaloid  is  Ci7H2jN04 ;  its  reaction  is  strongly  alkaline. 

The  two  forms  in  which  cocaine  is  most  generally  used  are 
the  hydrochlorate  or  muriate  and  the  oleate.  The  hydrochlor- 
ate of  cocaine  is  generally  employed  in  surgery,  and  is  in  the 
form  of  a  white  crystalline  powder,  which  is  sparingly  soluble 
in  water,  but  readily  soluble  in  alcohol,  ether,  oil  and  vaseline. 
At  first  a  2  per  cent,  solution  was  used,  but  subsequently  it 
was  increased  to  four,  five,  ten,  and  twenty  per  cent.  Merck 
has,  however,  introduced  a  new  preparation  known  as  the 
Citrate  of  Cocaine,  in  the  form  of  pills,  made  by  incorporating 
it  with  gum  tragacanth  dissolved  in  glycerine,  each  pill  con- 
taining ]/i  grain  of  the  citrate,  in  which  form  it  retains  its 
strength.  The  citrate  of  cocaine,  however,  in  solution,  will 
decompose  in  three  or  four  days. 

Dr.  John  S.  Marshall,  from  experiments  made  with  the 
citrate  of  cocaine,  is  of  the  opinion  that  it  is  more  reliable 
when  applied  to  hypersensitive  dentine  or  to  the  dental  pulp, 
than  the  first  two  forms,  but  appears  to  possess  no  special  ad- 
vantages over  them  for  operations  on  submucous  tissues  or 
in  the  extraction  of  teeth. 

Another  new  salt  of  cocaine,  the  hydrobromate,  has  been 
produced  by  Dr.  Lyons  by  a  combination  of  hydrobromic  acid, 
with  cocaine,  in  the  form    of  slender,  translucent   prisms,  of 


306  DENTAL   MEDICINE. 


snowy  whiteness.  It  is  claimed  that  the  local  anaesthetic 
effect  of  this  preparation  is  greater,  for  the  same  amount  of 
solution,  than  that  of  any  of  the  other  salts  employed. 

Medical  Properties  and  Action. — Dr.  Niemann,  of  Goslar,  as 
early  as  i860,  noted  the  fact  that  cocaine,  when  applied  to  the 
tongue,  produced  local  anaesthesia  but  his  investigations,  as 
well  as  those  of  others  at  a  later  period,  appear  to  have  been 
forgotten,  until  1884,  when  Dr.  KoUer,  of  Vienna,  demonstrated 
the  action  of  cocaine,  in  solution,  on  the  eye.  Apparently 
very  little  is  known  concerning  the  physiological  action  of 
cocaine,  but  that  it  is  a  valuable  local  anaesthetic  and  local 
anodyne  is  beyond  question.  It  appears  to  paralyze  the  nerves 
of  the  vessels,  causing,  at  the  same  time,  a  constriction,  as  is 
evident  from  the  blanching  of  the  part  acted  on.  Many  are 
of  the  opinion  that  its  effects  are  mainly  due  to  its  influence 
upon  the  sympathetic.  When  one  drop  of  a  2  or  4  per  cent, 
solution  of  cocaine  is  applied  to  the  eye,  a  slight  burning 
sensation  is  felt,  and  a  minute  or  two  later  the  cornea  and  con- 
junctiva become  anaesthetized,  and  lose  all  reflex  excitability* 
The  finger  can  be  passed  over  the  cornea  and  conjunctiva,  and 
the  latter  can  be  taken  up  with  the  forceps,  without  pain.  At 
the  same  time  there  is  a  feeling  of  tension  in  the  lids,  and  the 
eyes  seem  protruding.  These  effects  last  about  ten  minutes 
and  gradually  disappear.  Dr.  Konigstein  reports  having  re- 
moved the  eyeball  of  a  dog  cocainized,  without  the  animal 
feeling  any  pain.  A  ten  or  twenty  per  cent,  solution  is  used, 
according  to  the  sensitiveness  of  the  parts  and  the  nature  of 
the  operation,  when  less  sensitive  organs  than  the  eye  have  to 
be  obtunded.  For  the  larynx,  it  should  be  applied  three  or 
four  times,  at  intervals  of  ninety  seconds  ;  for  the  eye,  a  drop 
of  the  two  per  cent,  solution,  at  intervals  of  two  minutes,  the 
maximum  effect  being  reached  in  fifteen  minutes.  Dr.  Jelinek 
recommends  a  dilute  alcoholic  solution  of  ten  or  twenty  per 
cent.  For  the  former  strength  the  proportion  of  alcohol  to 
water  should  be  one  to  four  ;  for  the  latter,  two  to  three. 

Therapeutic  Uses. — Cocaine  is  employed  in  some  forms  of 
insanity,  melancholia,  neurasthenia,  gastralgia  and  in  wasting 


COCAINE.  307 

diseases,  pruritic  skin  affections  and  hoarseness.  The  leaves 
in  cigarettes  have  relieved  hay  fever  and  throat  affections.  Co- 
caine is  employed  as  a  local  anaesthetic  and  local  anodyne  in 
all  painful  affections  of  the  eye,  the  operation  for  cataract,  al- 
though the  evidence  as  to  its  reliability  in  such  deep  opera- 
tions as  iridectomy,  cataract,  squint,  etc.,  is  conflicting.  (There 
are,  however,  cases  reported  by  Dr.  Konigstein  of  even  the 
surfaces  of  the  eyelids  entirely  losing  their  sensitiveness  when 
hydrochlorate  of  cocaine  was  applied  in  solid  form.)  It  is  also 
employed  in  painful  affections  of  the  pharynx  and  larynx,  or 
of  any  other  excitable  mucous  membrane  or  of  nerve  tissue. 
Prof  Engle  reports  a  case  of  trigeminal  neuralgia  successfully 
treated  by  hypodermic  injections  of  the  hydrochlorate  of  co- 
caine. Dr.  Wagner  of  Vienna,  basing  a  theory  upon  the  es- 
tablished principle  that  fluids  move  from  the  positive  to  the 
negative  pole  in  a  galvanic  current,  saturated  the  positive  elec- 
trode with  a  strong  cocaine  solution,  applied  it  to  the  skin,  and 
applied  the  negative  pole  a  short  distance  from  the  positive,  and 
found  that  incisions  could  be  made  without  producing  any  pain. 

Dr.  Lewis  H.  Adler,  Jr..  writing  on  the  status  of  hydrochlor- 
ate of  cocaine  in  minor  surgery  says  : 

"  In  minor  surgery,  cocaine,  when  used  hypodermically,  is 
of  value  in  all  operations  in  which  the  circulation  can  be  tem- 
porarily arrested,  in  order  to  prevent  undue  absorption  of  the 
drug,  and  in  which  free  bleeding  can  be  encouraged  at  the 
completion  of  the  operation  previous  to  the  tying  of  the  sutures, 
to  allow  as  much  of  the  unabsorbed  cocaine  to  be  washed  out 
as  is  possible.  Attention  paid  to  these  two  essential  points 
will,  as  a  rule,  obviate  any  untoward  results  from  the  use  of 
cocaine  employed  hypodermically  for  anaesthetic  purposes.  It 
is  likewise  important  to  make  use  of  freshly  prepared  solutions, 
as  otherwise  the  formation  of  fungi  is  liable  to  occur  and  the 
preparation  to  be  spoiled.  To  prevent  this  alteration,  antisep- 
tic agents  are  added,  the  best  one  being  boracic  acid,  as  it  is 
the  least  irritating.  Such  a  solution  usually  consists  of  about 
twenty  grains  of  cocaine  and  ten  grains  of  boracic  acid,  dis- 
solved in  an  ounce  of  distilled  water.     A   preparation   of  this 


308  DENTAL  MEDICINE. 


character  has  been  used  by  the  writer  with  perfectly  satisfactory 
results,  even  when  it  has  been  over  two  months  old. 

Another  point  of  considerable  importance  in  using  cocaine 
hypodermically  is  to  make  use  of  a  perfectly  aseptic  syringe ; 
frequently  in  cases  where  the  drug  is  so  used  and  suppuration 
follows,  it  is  the  fault  of  want  of  cleanliness  in  this  particular, 
and  not  to  the  employment  of  the  drug, 

A  four  per  cent,  solution  is  as  strong  as  need  be  used  for 
hypodermic  injections.  The  principal  advantages  in  using  a 
solution  of  no  greater  strength  are,  that  the  anaesthetic  prop- 
erty of  cocaine  can  be  made  to  reach  to  a  larger  area  with  a 
less  amount  of  the  drug  than  is  the  case  when  a  more  concen- 
trated one  is  employed  ;  and,  furthermore,  the  dilution  of  the 
drug  renders  it  less  liable  to  produce  toxic  symptoms. 

When  the  circulation  cannot  be  controlled,  extreme  caution 
must  be  observed  in  the  use  of  the  drug,  especially  is  this  the 
case  when  any  considerable  quantity  is  required. 

The  quantity  of  cocaine  required  to  produce  anaesthesia 
varies  with  the  operation  and  its  extent ;  as  a  rule  for  ordinary 
minor  operations  from  25  to  40  minims  of  a  four  per  cent, 
solution  are  needed.  The  length  of  time  necessary  for  the 
production  of  local  anaesthesia  or  insensibility  under  cocaine 
varies  from  three  to  ten  minutes, 

Individual  susceptibility  to  the  toxic  influence  of  cocaine  is 
a  complication  of  sufficiently  frequent  occurrence  to  surround 
the  use  of  the  drug  with  due  care  and  caution,  but  it  is  not  a 
contraindication  to  the  employment  of  the  agent  as  an  anaes- 
thetic. Untoward  effects  may  arise  from  the  use  of  any 
one  of  the  anaesthetic  substances. 

Another  objection  urged  by  some  surgeons  to  the  employ- 
ment of  cocaine  for  anaesthetic  purposes  is  based  on  its  asserted 
power  of  inducing  the  so-called  "  cocaine  habit."  As  yet,  this 
influence  of  the  drug  is  extremely  rare.  It  is  most  liable  to 
occur  among  the  patients  who  are  informed  of  the  nature  of 
the  remedy  used,  and  especially  is  this  the  case  when  it  is  em- 
ployed internally  for  medicinal  purposes.  I  hardly  believe 
that  this  action  of  cocaine  can  be  produced  when  it  is  employed 


COCAINE.  309 

for  its  local  anaesthetic  effect  and  in  the  small  quantity  needed 
to  induce  local  insensibility."  Dr.  Edward  T.  Reichert,  from 
a  careful  study  of  the  actions  of  cocaine  on  the  circulation  in 
animals,  deduced  the  following  conclusions :  i.  The  discrep- 
ancies in  the  testimony  offered  by  different  experimenters,  in 
their  investigations  of  the  action  of  cocaine  on  the  circulation, 
are  almost  wholly  due  to  variations  in  the  absolute  doses  em- 
ployed, and  to  the  individual  susceptibility  of  the  animals- 
2.  The  minimal  fatal  dose,  when  injected  intravenously  in 
divided  doses  in  the  form  of  a  one  per  cent,  solution,  varies 
from  0.004  to  0.03  gramme  to  the  kilo  of  the  body  weight. 
Owing  to  the  great  differences  in  the  sensitiveness  of  different 
dogs  to  the  poison,  a  moderate  dose  in  one  animal  might 
prove  a  small  or  a  large  one  in  another  of  similar  weight.  3, 
When  the  full  train  of  effects  on  the  heart-beat  is  slowly  de- 
veloped by  the  repeated  injection  of  very  small  doses  (0.00 1 
gramme  to  the  kilo  of  body  Vk^eight),  the  pulse  rate  is  at  first 
decreased,  then  increased,  and  finally  decreased.  A  single  very 
small  dose  causes  a  decrease,  a  small  to  a  moderate  dose  an 
increase  ;  large  doses  a  transient  decrease  followed  by  an  in- 
crease ;  very  large  doses  a  more  or  less  permanent  decrease. 
The  primary  decrease,  which  only  can  be  developed  by  very 
small  doses,  is  due  to  a  stimulation  of  the  cardio-inhibitory 
centres  ;  the  secondary  increase  to  a  depression  of  the  same 
centres,  and  which  may  be  assisted  by  a  similar  action  on  the 
cardio-inhibitory  peripheries  ;  and  the  final  decrease  to  a  de- 
pression either  of  the  accelerator  or  automatic  motor-ganglion 
in  the  heart.  The  height  of  the  pulse  curves  during  these 
changes  is  always  in  adverse  relation  to  the  frequency  of  the 
beat.  4.  The  cardio-inhibitory  centres  are  invariably  affected, 
being  primarly  stimulated,  and  secondarily  depressed;  but  the 
action  on  the  peripheries  is  of  a  very  inconsistent  character, 
although  a  primary  stimulant  action  is  never  manifest  the 
depressant  action  is  sometimes  present  to  a  profound  degree 
very  early  in  the  poisoning,  and,  at  others,  absolutely  absent 
up  to  the  time  of  death.  5.  The  arterial  pressure  is  always 
increased,  unless  it  be  after  large  doses,  when  it  may  temper- 


310  DENTAL   MEDICINE. 


arily  be  diminished,  followed  by  a  rise  above  the  normal ;  or 
after  very  large  doses,  be  permanently  lowered.  The  increase 
may  be  decided  long  after  the  development  of  the  third  stage 
of  the  actions  of  the  heart,  and,  therefore,  may  outlast  the 
period  of  the  acceleration  of  the  heart's  beat.  The  increase  is 
chiefly  due  to  a  stimulation  of  the  vaso-motor  centres  in  the 
medulla  oblongata:  to  a  slight  stimulation  direct  of  the  vessel- 
walls  ;  and  to  the  acceleration  of  the  pulse.  The  final  fall  of 
pressure  is  chiefly  dependent  upon  a  depression  of  the  heart, 
and  partly  to  vaso-motor  depression.  6.  The  effects  of  cocaine 
in  normal  and  curarized  animals  are  identical,  unless,  in  the 
latter,  the  curare  has  been  used  to  excess.  7.  Cocaine  is  a 
decided  circulatory  stimulant. 

Dental  Uses. — In  operations  in  the  mouth,  affecting  the 
mucous  membrane  and  the  immediately  subjacent  tissues, 
the  salts  of  cocaine  have  proven  efficient  for  their  local  anaes- 
thetic and  anodyne  effects.  But  for  operations  on  deep-seated 
tissues,  such  as  are  involved  in  the  extraction  of  teeth,  the 
action  of  cocaine  has  been,  as  Dr.  W,  W.  Allport  remarks,  "so 
uncertain  as  to  render  its  practicable  benefits  questionable." 
Cocaine  has,  however,  proven  very  efficient  in  relieving  the 
pain  of  the  surgical  treatment  of  alveolar  pyorrhoea,  the  extir- 
pation of  the  pulps  of  teeth,  and,  in  some  cases,  that  of  hyper- 
sensitive dentine.  Exposed  pulps  are  rendered  less  painful  after 
being  treated  with  a  five  per  cent,  solution  of  cocaine,  to  which, 
in  some  cases,  morphine  has  been  added.  In  some  cases  also, 
it  is  claimed,  highly  inflamed  pulps  have  been  successfully  cap- 
ped, as  an  experiment,  with  a  paste  of  cocaine  and  glycerine, 
although,  as  was  foreseen,  the  anaesthetic  did  not  arrest  the 
course  of  the  pulpitis.  In  treating  hypersensitive  dentine,  the 
more  sensitive  the  structure  the  stronger  the  solution  of  cocaine 
to  be  employed.  The  pure  cocaine  in  the  form  of  crystals,  of 
the  hydrochlorate  or  other  salts,  in  the  form  of  powder,  have 
proven  efficient  when  applied  to  hypersensitive  dentine ;  while 
the  twenty  per  cent,  solution  of  the  salts  have  relieved  the 
acute  pain  which  is  common  to  such  a  condition.  It  is  also 
claimed  that  the  crystals  of  cocaine,  applied  to  the  gum,  close 


COCAINE.  311 

to  a  tooth  to  be  extracted,  three  times,  at  intervals  of  two 
minutes  each,  has  secured  a  painless  operation.  It  has  been 
suggested  that  immediately  after  the  application  of  the  cocaine 
crystals  to  the  gum,  three  or  four  minims  of  a  four  per  cent, 
solution  be  injected  with  a  hypodermic  syringe,  between  the 
gum  and  the  neck  of  the  tooth  to  be  extracted.  For  the  extir- 
pation of  pulps  of  teeth,  it  is  recommended  first  to  anaesthetize 
the  pulps  superficially,  with  a  paste  of  cocaine  and  glycerine, 
and  then  to  introduce,  by  means  of  a  syringe,  a  twenty  per 
cent,  solution  of  cocaine  directly  on  the  exposed  portion  of  the 
pulp,  when  it  can  be  removed  with  a  nerve  extractor  without 
causing  any  pain.  Dr.  John  S.  Marshall,  from  his  experiments 
with  the  pills  of  citrate  of  cocaine,  found  that  under  favorable 
circumstances,  the  citrate,  in  such  a  form,  produces  anesthesia, 
when  applied  to  sensitive  dentine,  in  from  five  to  ten  minutes, 
and  that  the  obtunding  effect  is  of  a  duration  sufficient  for  the 
preparation  of  the  cavity.  He  was  also  able  to  extirpate  the 
pulp  of  a  tooth,  after  the  citrate  had  been  applied,  in  from  three 
to  twelve  minutes.  In  using  the  citrate  in  the  form  of  pills, 
one  pill  is  introduced  into  the  sensitive  cavity,  and,  after  being 
secured  with  a  pledget  of  cotton,  moistened  in  tepid  water, 
is  permitted  to  remain  from  five  to  twelve  minutes.  Dr.  Mar- 
shall suggests  the  use  of  granules,  containing  one-sixteenth  of 
a  grain  of  pure  citrate  of  cocaine,  instead  of  pills  containing 
glycerine  and  saccharine  matters.  A  solution  of  the  salts  of 
cocaine  has  also  been  subcutaneously  injected,  with  favorable 
results,  for  the  relief  of  the  pain  resulting  from  periodontitis 
and  dental  exostosis  ;  and  Dr.  Hillischer  recommends  the  rub- 
bing in  of  concaine,  either  in  substance  or  in  concentrated 
solution,  after  the  epithelium  has  been  macerated  with  tincture 
of  iodine,  to  promote  absorption,  to  relieve  the  pain  of  chronic 
periodontitis;  also  the  repeated  application  of  the  concentrated 
solution  to  relieve  the  ulcers  of  thrush,  aphthai,  etc.  In  the 
surgical  treatment  of  alveolar  pyorrhcea,  the  pain  may  be  re- 
lieved by  first  applying  dilute  alcohol  to  the  gums,  by  means 
of  a  camel's  hair  brush,  and  then  in  the  same  manner,  a  ten 
per  cent,  solution  of  cocaine,  repeating  the  application  of  the 


312  DENTAL   MEDICINE. 


cocaine  once  or  twice  during  the  space  of  five  minutes.  The 
slowness  of  the  action  of  cocaine  is  a  great  objection  to  its  use 
as  an  anaesthetic. 

The  four  per  cent,  or  five  per  cent,  solution  applied  to  a 
tooth  unprotected  by  a  rubber  dam  (as  the  rubber  prevents 
the  anaesthetic  action  of  the  agent),  for  the  space  of  twenty 
minutes,  repeating  the  application  if  necessary,  is  recom- 
mended by  Dr.  Thompson.  Dr.  A.  W.  Harlan  recommends 
a  solution  composed  of  cocaine  hydrochlorate,  ten  grains,  in 
sulphuric  ether,  ninety  minims,  which  is  to  be  applied  for  four 
or  five  minutes,  for  the  painless  extirpation  of  an  exposed 
pulp. 

Dr.  Harper  recommends  the  following  method  for  removing 
pulps  of  teeth  by  the  use  of  crystals  of  cocaine :  * '  Take  a 
drop  of  the  oil  of  cloves  and  add  enough  cocaine  to  make  a 
thick  paste  and  introduce  it  into  the  pulp,  after  having  first  put 
the  rubber  dam  on  the  tooth  ;  then  with  a  broach  slowly  work 
it  down ;  with  a  bur  open  up  the  opening  slowly,  and  in  ten 
or  fifteen  minutes  the  pulp  may  be  removed  from  any  of  the 
anterior  teeth."  Where  arsenic  has  been  applied  to  the  pulp 
and  the  patient  returns  with  pain,  he  finds  that  he  can  get 
better  satisfaction  from  the  application  of  cocaine. 

Herbsfs  Obtundent  consists  of  a  saturated  solution  of  cocaine 
hydrochlorate  in  chemically  pure  sulphuric  acid,  to  which  sul- 
phuric ether  is  added  to  the  point  of  saturation,  the  excess  of 
the  ether  floating  upon  the  surface  and  evaporating.  Several 
applications  are  necessary  to  produce  anaesthetic  effects,  and 
seventy  grains  of  cocaine  hydrochlorate  are  required  to  satu- 
rate two  drachms  of  the  sulphuric  acid. 

Cocaine,  owing  to  the  unsatisfactory  results  which  have 
attended  its  use  as  a  local  application,  is  now  generally  applied 
by  hypodermic  injection,  for  the  extraction  of  teeth.  Owing 
to  the  necessity  for  introducing  the  agent  deeply  into  the  tis- 
sues. Dr.  Walb's  method  is  to  inject  a  two  per  cent,  solution 
of  the  hydrochlorate  of  cocaine  hypodermically  over  the  root 
of  the  tooth  to  be  extracted,  the  injections  being  usually  made 
on  each  side  of  the  gum,  above  the  root  of  the  tooth,  and  as 


COCAINE.  313 

many  as  the  number  of  teeth  to  be  extracted  may  indicate  ;  the 
same  method  is  employed  for  obtunding  hypersensitive  den- 
tine, and  in  removing  pulps.  The  full  anaesthetic  effect  is  de- 
veloped in  from  five  to  ten  minutes,  and  continues  ten  cr  fifteen 
minutes.  It  has  also  been  suggested  to  hypodermically  inject 
the  solutions  of  cocaine  upon  both  the  lingual  branch  and  the 
inferior  dental  branch  of  the  inferior  maxillary  nerve,  the 
former  being  preferred  by  some,  on  account  of  its  supplying 
the  alveoli  and  gums  ;  but  greater  success  appears  to  result 
from  injecting  the  gum  on  each  side  of  the  tooth.  Dr.  Ray- 
mond recommends  charging  the  syringe  with  thirteen  minims 
of  a  four  per  cent,  solution  of  cocaine,  and  to  direct  the  needle- 
point on  a  line  extending  about  midway  between  the  angle 
and  the  coronoid  process  of  the  inferior  maxillary,  passing 
through  the  internal  pterygoid  muscle,  and,  using  the  finger 
on  the  internal  oblique  line  as  a  guide,  to  carry  the  needle- 
point along  inner  surface  of  ramus  until  the  nerve  is  reached, 
where  it  enters  the  inferior  dental  foramen,  for  operations  on 
the  inferior  molar  teeth. 

Dr.  Raymond  also  suggests  the  following  method  of  pre- 
paring and  applying  cocaine :  Obtain  a  quantity  of  the 
soluble  alkaloid,  and  mix  it  at  the  time  of  using  it  (as  it  de- 
teriorates when  long  kept).  The  requisites  are  a  minim  glass, 
pair  of  scales,  some  filtering  paper,  and  a  little  water  that  has 
been  boiled.  It  is  necessary  to  have  an  easy-working  syringe, 
with  a  perfectly  smooth,  sharp  needle.  Care  must  be  taken 
to  exhaust  the  air  from  the  syringe  when  charged  ready  for 
use.  This  can  be  done  by  drawing  in  more  of  the  solution 
than  is  needed,  and  pressing  it  out  to  the  required  number  of 
minims.  Hold  the  needle-point  up,  so  as  to  allow  the  air  to 
get  above  the  solution,  then  press  the  piston. 

The  needle  of  the  hypodermic  syringe  should  be  fine,  sharp, 
and  clean,  and  rendered  thoroughly  aseptic  previous  to  its 
employment,  which  may  be  accomplished  by  drawing  up 
through  it  a  few  drops  of  any  good  antiseptic  solution,  such 
as  strong  carbolic  acid,  and  the  solution  should  be  freshly 
prepared  for  each  operation  as  the  salts  of  cocaine  rapidly  de- 


314  DENTAL   MEDICINE. 


compose.  The  salt  should  be  dissolved  in  slightly  warm 
water,  and  the  strength  of  the  solution  vary  from  5  to  20  per 
cent.  A  five  per  cent,  solution  is  made  by  dissolving  yi 
grain  in  10  minims  of  water.  Previous  to  the  injection,  the  gum 
should  be  dried  about  the  tooth,  and  a  folded  napkin  so  placed 
as  to  exclude  the  saliva.  All  air  must  be  expelled  from  the 
syringe,  and  the  gum  at  the  point  the  needle  of  syringe  is  to 
enter,  should  be  obtunded  by  applying  a  few  drops  of  the 
solution  to  the  mucous  membrane,  so  as  to  render  the  punc- 
ture painless.  It  is  recommended  to  inject  the  solution  at 
three  points,  two  punctures  on  the  labial  or  buccal  surface, 
and  one  on  the  palatine  or  lingual  surface.  The  point  of  the 
needle  should  be  inserted  about  one-sixth  of  an  inch  below 
the  free  margin  of  the  gum,  and  pressed  in  obliquely,  upwards 
or  downwards,  as  the  case  may  be,  in  a  direction  towards  the 
apex  of  the  tooth,  until  the  point  of  the  needle  rests  against 
the  bone  ;  all  of  the  soft  tissues  must  be  penetrated.  With  the 
needle  in  position,  and  a  finger  placed  on  either  side  and 
pressed  with  some  force  against  the  gum  to  keep  the  tissues 
in  place,  the  solution  should  be  slowly  injected,  when  the  gum 
should  appear  completely  blanched  in  the  neighborhood  of 
the  puncture.  After  injecting  the  solution,  the  needle  should 
not  be  withdrawn  for  several  seconds,  and  then  a  finger  should 
be  placed  over  the  puncture  to  prevent  any  escape  of  the  solu- 
tion. Some  six  or  seven  minutes  elapse  before  the  full  anaes- 
thetic effects  of  the  cocaine  are  obtained.  Dr.  Gask  recom- 
mends placing  a  few  crystals  of  the  salt  just  around  the  neck 
of  the  tooth  to  render  painless  the  application  of  the  forceps, 
and  he  prefers  for  injection  hydrochlorate  of  cocaine  in  the 
form  of  half-grain  tabloids. 

The  combined  use  of  cocaine  and  chloroform  is  advocated  by 
Obolinski,  who  injects,  either  before  or  after  the  anaesthesia  is 
obtained,  from  one  to  three  centigrammes  of  cocaine ;  or  he 
injects  in  the  neighborhood  of  the  seat  of  operation,  and  dur- 
ing its  progress,  from  three  to  seven  centigrammes.  Cocaine 
is  thus  used  on  the  ground  that  it  is  a  complete  antagonist  to 
chloroform,  of  which,  however,  there  is  some  doubt,  as  cocaine 


COCAINE.  315 

is  rather  a  general  excitant  of  the  central  nervous  gray  matter 
than  a  direct  and  powerful  stimulator  of  the  heart,  while  its 
stimulant  effect  upon  respiration  is  not  to  be  depended  upon. 
Obolinski  claims  that  this  mixed  narcosis  requires  the  use  of 
less  chloroform,  that  vomiting  is  prevented,  and  that  there  are 
few  disagreeable  after-effects.  Dr.  Gordon  White  recommends 
a  saturated  solution  of  cocaine  hydrochlorate  in  ether  as  an 
excellent  preparation  for  sensitive  dentine  and  pulp-extirpation. 

Dr.  A.  C.  Gask  recommends  painting  the  palate  with  a  five 
per  cent,  solution  of  cocaine  for  obtaining  impressions  of 
mouths  which  exhibit  great  intolerance  to  the  introduction  of 
all  impression  materials  ;  also  a  20  per  cent,  solution  applied 
to  the  mucous  membrane  on  cotton,  for  service  in  wedging 
and  separating  teeth,  in  forcing  silk,  etc.,  up  in  high  conical 
edges,  in  removing  portions  of  overhanging  gum,  in  lancing 
abscesses,  in  treating  alveolar  pyorrhoea,  in  extirpation  of 
pulps,  and  in  the  treatment  of  teeth  very  sensitive  from  perio- 
dontitis ;  also  in  the  form  of  a  ^  grain  compressed  tabloid 
placed  in  the  cavity,  to  relieve  the  pain  following  extraction. 

The  dangers  from  the  use  of  cocaine  are  enumerated  as 
follows  :  Certain  persons  possess  an  idiosyncrasy  to  cocaine, 
which  cannot  be  foreseen  or  entirely  guarded  against;  it  exerts 
its  toxic  effects  upon  the  nervous  centres  and,  secondarily,  the 
heart;  its  evil  effects  are  most  liable  in  neurotic  subjects  ;  the 
danger  in  cocaine  poisoning  is  mainly  from  paralysis  of  the 
heart,  syncope;  special  care  is  necessary  in  "weak  heart"  and 
organic  heart  disease;  many  regard  its  subcutaneous  adminis- 
tration as  dangerous,  and  that  it  should  be  avoided  ;  the  use 
of  the  strongest  solutions  is  dangerous  and  unnecessary;  that 
it  may  be  well  to  precede  its  use  by  the  administration  of 
alcohol  or  other  cardiac  stimulant,  as  is  done  with  chloroform. 

Patients  of  a  sanguine  temperament  and  in  good  health  are 
the  most  favorable  subjects  in  the  use  of  cocaine ;  while  the 
nervous,  hysterical,  and  those  exhibiting  great  dread  of  the 
impending  operation,  as  well  as  pregnant  women,  may  be  re- 
garded as  unfavorable  subjects.  Great  care  should  also  be 
taken  to  prevent  even   the  weakest  solution  of  eocaine  from 


316  DENTAL   MEDICINE. 


running  down  into  the  fauces,  and  restorative  agents  should 
always  be  at  hand. 

Cocaine  appears  to  be  absorbed  with  extraordinary  rapidity, 
and  the  stronger  the  solution  which  is  locally  applied,  the 
greater  the  danger  of  toxic  symptoms.  The  rapidity  of  the 
absorption  varies  in  the  different  tissues,  absorption  occurring 
most  rapidly  through  the  conjunctiva,  then  through  the  nose, 
larynx,  mouth,  and  ear.  A  ten  per  cent,  solution  is  sufficiently 
strong  for  most  purposes,  and  is  less  dangerous  than  one  of 
greater  strength. 

The  treatment  of  cocaine  poisoning  consists  of  measures  to 
rouse  the  heart,  especially  inhalations  of  the  nitrite  of  amyl, 
and  such  restoratives  as  brandy,  whiskey,  aromatic  spirits  of 
ammonia,  strychnine,  atropine,  digitalis,  ether  and  chloroform 
(when  convulsions  are  present),  or  five  minims  of  carbonate  of 
ammonia  by  injection,  also  nitrite  of  amyl  by  inhalation.  The 
hot-baths,  hot  drinks,  and  hot  sinapisms  over  the  heart,  and 
friction  are  often  serviceable ;  also  artificial  respiration. 

Cocaine  is  also  employed  in  combination  with  arsenious 
acid  for  a  devitalizing  mixture.     (See  Arsenious  Acid). 

Cocaine  Incompatible s. — When  combined  with  nitrate  of  sil- 
ver, decomposition  of  the  hydrochloride  occurs  with  the  for- 
mation of  an  insoluble  chloride  of  silver,  and  a  corresponding 
change  in  the  cocaine.  If  calomel  and  hydrochlorate  of  co- 
caine are  rubbed  together,  chemical  reaction  begins.  Added 
to  mercuric  oxide,  an  irritating  instead  of  an  anaesthetic  ac- 
tion is  produced,  due  to  the  formation  of  oxychloride  of  mer- 
cury. 

DENTAL    FORMULA. 

To  Make  a  Solution  of  Hydrochlorate  Spiritus  menthas  pip  .    .  f^j.    M. 

of  Cocaine  (four  per  cent.).  SiGNA.— Apply  on  a  pledget  of  cotton. 


For  Local  Ancesthesia. 


R .     Cocaini       hydrocMoratis 

(cryst.) gr.  2X 

Aquse  destillatae .  .    .    .  f^j.    M.  H.   J.  McKellops. 

For  Exposed  Pulps.  g .     Mur.  cocaini gr.iss 

R.     Cocaini       hydrochloratis  Spts.  alcoholis ^] 

(cryst.) gr.vj  Chloroformi ^j.      M, 


COCAINE. 


317 


For  Neuralgia  and  Odontalgia. 
fi .     Cocaini      hydrochloratis 

(crj-st.) gr.vj 

Menthol gr.xxx 

Alcoholis  .  qs.  .  ad  .    .  f^j.     M. 
SlGNA. —  Apply   as   a   lotion,  or   on   a 
pledget  of  cotton. 

Chloroform  or  bromide  of  ethyl  may 
be  substituted  for  the  alcohol. 

To  Make  Oleaie  of  Cocaine. 
(Five  per  cent.) 
R.     Cocaine  (alkaloid)  .  .    .  gT.2^ 
Acidi  oleic  (pure) .    .    .  ITtxx 
Olei  amygdalffi  ....  TTLxl. 
Dissolve  the   alkaloid   in   the   oleic 
acid  and  add  the  almond  oil. 

For  Pain  of  Difficult  Dentition. 

M.  VlQUIER. 

R.     Cocaini  hydrochloratis  .  gr.ij 

Syrup  simp 3  ijss 

Tinct.  saffron gtt.x.    M. 

SiGNA. —  Rub   the    painful    gums    fre- 
quently during  the  day. 

For  Local  Ancesthesia. 

J.  M.  Lewis. 

R .     Cocaini  hydrochloratis.  grs.viii 

Chloralis  hydrat  .    .    .  gr.v 

Acidi  carbolici ....  gtt.iij 

Aquae  destil f^i'j-     ^^• 

SiGNA. —  Inject  two  or  three  drops  into 
the  gum. 

For  Hypersensitive  Dentine. 
R .     Cocaini      hydrochloratis 

(cr>-st.) gr.x 

Tragacanth.  glyceritum  q.s. 
Form  a  mass. 
SiG.VA. — Insert    a    minute    portion    in 
cavity  half  an  hour  before  operating. 

For  Neuralgia  and  Odontalgia, 
R .     Cocaini      hydrochloratis 

(cryst.) gr.xv 

Olei  caryophylli  .  .    .    .  f3J.     M. 
Sic.VA. — Apply  as   a   lotion,   or   on    a 
pledget  of  cotton. 


Local  AncEsthetic. 
R.     Cocaine  hydrate  (4    per 

cent,  solution)  .  .    .    .   5iij 

Carbolic  acid gtt.v 

Chloral  hydrate  .    .        .  gr.v.    M. 
S. — Use  hj-podermically  around   tooth 

with  care. 
Local  Ancestketic  for    Extraction   of 
Teeth. 
Dr.  J.  W.  Hope. 
R.     Cocaini   hydrochloratis  .  5  parts 

Acidi  carbolici 6    " 

Camphorse  (Pine  gum)  .  6    " 
Alcoholis  (95  pr.  ct.)  q.s. 

to  make  I20  parts.    M. 
S. — Inject  with  a  hj-podermic  sjTinge 
one  to  three  minims  deeply  into  inner 
and   outer  surfaces  of  gum.     Apply 
over  the  gum  absorbent  cotton  satu- 
rated with  the  solution.     Wait  4  or 
5  minutes. 
Local  AncEsthetic  for  Gums  and  Sensi- 
tive Dentine. 
Dr.  Martin. 

R.     Cocaine gc.% 

Antipyrine gr.vj 

Aq.  destil TTLxvj.M. 

Prof.  J.  E.  Michael  suggests  2  grains  of 
acetanilid  as  a  substitute  for  the  antipy- 
rine. 

For  Stomatitis  and  Difficult    Teething 
of  Children. 

INTERNAT.  KLIN.  RUNDSCHAU. 

1.  Paint  the  gums  with  the  following 
mixture : 

R.     Cocainaemur gr.  iss. 

Sodii  chlor gr.  xv. 

Glycerini, 

Aquae  dest aa  3  iiss. 

2.  Spray  a  boracic  acid  solution  on 
the  inflamed  parts. 

3.  To  prevent  spasms  give  internally  : 
R.     Potassiibrom gr.  xv. 

Syr.  alth .5  v, 

Salep.  gummos SJ'S'J- 

M.— S.  Teaspoonful  every  hour. 


318  DENTAL   MEDICINE. 


For  Irritation  of  the  Gums. 
M.  F.  Besnier. 
R.     Hydrochlorate  of  Cocaine  .    .  •    .    .    .    gr.| 

Bromide  of  Potassium gr.vii  ss. 

Distilled  water 

Glycerine •   .    .    .    .    aa  TTtcl.     M. 

COLCHICUM— MEADOW  SAFFRON. 

Source. — Colchicum  root — Colchici  radix  ;  Colchicum  seed 
—  Colchici  semen,  the  bulb  and  seed  of  the  Colchicum  Autum- 
nali.  Colchicum  contains  tannic  and  gallic  acids  and  an 
alkaloid  known  as  colchicine,  which  is  the  active  principle; 
colchicum  also  contains  starch,  sugar  and  gum.  It  has  a  bitter 
taste,  and  imparts  its  medicinal  virtues  to  water,  alcohol  and 
ether ;  wine  and  vinegar  extracting  all  its  properties. 

Medical  Properties  and  Therapeutic  Uses. — Colchicum,  in 
the  forms  of  fluid  extract,  wine  and  tincture,  increases  the 
mucous  and  glandular  secretions  of  the  stomach,  intestines, 
liver,  kidneys  and  skin,  and  causes  an  increased  flow  of  saliva, 
and  also  of  urine.  A  large  dose  may  produce  heat  in  the 
epigastrium,  nausea,  vomiting,  depression  of  the  circulation, 
muscular  feebleness  and  pain  in  the  head,  large,  watery  stools 
and  an  increased  secretion  of  biliary  matters.  In  poisonous 
doses  it  produces  all  the  symptoms  of  an  irritant  poison,  such 
as  acute  pain  in  abdomen,  profuse  watery  and  mucous  dis- 
charges, suppression  of  urine,  cold  extremities  and  feeble 
pulse ;  also  muscular  cramps,  in  some  cases.  Colchicum  is 
principally  employed  in  gout,  when  a  quantity  sufficient  to 
shorten  the  duration  of  an  acute  attack  and  reduce  the  swell- 
ing by  an  increased  secretion  from  the  skin,  intestines  and 
kidneys,  is  only  required.  It  is  often  combined  with  an  alkali, 
such  as  aromatic  spirits  of  ammonia,  bicarbonate  of  potassium, 
or  carbonate  of  magnesia,  to  increase  its  effect.  The  active 
principle,  colchicine,  is  generally  more  efficacious  than  the 
crude  colchicum.  It  is  very  serviceable  in  rheumatic  gout 
when  combined  with  alkalies,  and  also  in  all  affections  depen- 
dent upon  a  gouty  diathesis,  such  as  constipation,  congestion 
of  the  liver,  and  headache  from  torpor  of  the  portal  circula- 


COLLODION.  319 


tion.  It  is  now  rarely  used  in  acute  rheumatism,  but  in 
chronic  rheumatism  it  often  proves  serviceable.  Its  use  is 
indicated  in  plethora,  constipation  and  deficient  action  of  the 
liver,  kidneys  and  skin. 

Dose. — Of  the  fluid  of  colchicum  root — Extractiim  Colchici 
Radicis  Fluidiim,  TTLij  to  ITLv.  Of  wine  of  colchicum  root — 
Vi?i7iin  Colchici  Radicis,  TTLv  to  TTlxxx.  Of  acetous  extract  of 
colchicum  root — Extractian  Colchici  Radicis,  gr.  ss  to  gr.  ij. 
Of  tincture  of  colchicum  (seed) — Tinctura  Colchici,  ITLx  to  5j- 

COLLODIUM— COLLODION. 

Derivation. — Collodion  is  a  solution  of  4  parts  of  pyroxylin 
in  70  parts  of  stronger  ether,  and  26  parts  of  alcohol.  Pyroxy- 
lin or  gun  cotton,  is  prepared  by  adding  a  mixture  of  nitric 
and  sulphuric  acids  to  cotton  freed  from  impurities. 

Collodion  is  a  colorless,  syrupy,  and  very  inflammable  liquid, 
with  a  strong  ethereal  odor.  By  long  standing  and  exposure, 
or  when  applied  to  a  surface,  it  deposits  a  thin,  transparent 
and  strongly  contractile  film,  which  is  insoluble  in  water  or 
alcohol.  It  should  be  kept  in  glass-stoppered  bottles.  It  is 
applied  by  means  of  a  camel-hair  brush.  When  it  becomes 
too  thick,  it  may  be  diluted  by  a  solution  consisting  of  ether, 
3  parts,  alcohol,  i  part. 

Medical  Properties  and  Action. — It  is  serviceable  as  an  emol- 
lient, and  its  action  is  mechanical,  as  it  draws  together  and 
holds  in  apposition  divided  parts,  and  protects  such,  as  well  as 
abraded  or  denuded  surfaces,  from  contact  with  the  air.  As 
the  ether  it  contains  evaporates,  the  surface  of  the  part  to  which 
it  is  applied  is  constringed,  and  a  degree  of  pressure  is  thus 
established,  which  is  very  useful  in  moderating  vascular  action, 
promoting  absorption,  and  changing  the  course  of  pus  which 
may  already  be  formed  into  a  direction  more  desirable.  On 
account  of  the  liability  of  collodion  to  crack  and  peel  off, 
these  objections  have  been  obviated  by  the  use  of  what  is 
known  as  Flexible  Collodion — Collodium  Flexile — (collodion, 
92  parts,  Canada  turpentine,  5  parts,  castor  oil  3  parts),  which 
is  softer  and  more  pliable  and  elastic. 


320  DENTAL  MEDICINE. 


Therapeutic  Uses. — Collodion  is  very  useful  in  ulcers, 
fissures,  incised  wounds,  abraded  surfaces,  erysipelas,  skin, 
diseases,  etc. 

Dental  Uses. — Collodion  is  a  very  useful  application  in  dental 
practice,  to  prevent  alveolar  abscesses  from  discharging  exter- 
nally on  the  face ;  for  such  a  purpose,  it  is  applied  in  successive 
layers,  so  as  to  act  as  a  compress,  and,  by  moderating  the 
vascular  action,  cause  absorption,  or  such  a  change  in  the 
direction  of  the  discharge  as  will  induce  it  to  open  in  the  mouth. 
It  is  also  employed  in  combination  with  carbolic  acid,  as  an 
application  for  odontalgia ;  when  introduced  on  cotton,  it  acts 
as  a  temporary  filling;  it  has  also  been  employed  for  arresting 
the  mucous  secretion  during  the  operation  of  filling  cavities 
near  to  or  under  the  margin  of  the  gum,  but  the  rubber  dam 
has  superseded  it  in  this  respect.  Combined  with  iron  and 
other  agents,  it  forms  a  styptic  preparation. 

In  the  dental  laboratory,  collodion,  in  the  form  of  a  colored 
preparation,  is  employed  to  coat  the  surfaces  of  the  plaster 
models  of  plastic  work,  and  when  not  applied  too  thick,  it 
protects  the  plaster  surface,  and  also  prevents  an  unsightly 
rubber  surface  on  that  part  of  the  plate  which  is  adapted  to 
the  mucous  surface  of  the  mouth.  When  this  preparation 
becomes  too  thick  for  use,  it  may  be  diluted  with  a  solution  of 
3  parts  of  ether  to  i  part  of  alcohol. 

Collodion  is  precipitated  by  carbolic  acid. 

Cantharidal  Collodion — Collodium  cum  Cantharide — is 
composed  of  cantharides  (Spanish  flies),  in  powder  60  parts, 
flexible  collodion,  85  parts,  commercial  chloroform,  q.  s.  The 
addition  of  one  per  cent,  of  Venice  turpentine  to  cantharidal 
collodion  will  prevent  the  disagreeable,  and,  at  times,  painful 
contraction  of  the  preparation  on  drying. 

Like  cantharides,  cantharidal  collodion,  when  locally  applied, 
excites  inflammation  of  the  skin  and  mucous  membrane,  which 
terminates  in  a  copious  secretion  of  serum  under  the  cuticle. 
It  produces  a  blister  in  the  same  time  as  the  ordinary  blister- 
ing plaster,  and  is  applied  with  greater  facility,  and  is  better 
adapted  to  cover  uneven  surfaces,  and  retains  its   place    more 


CONIUM. 


321 


certainly.  It  acts  much  more  readily  if  the  evaporation  of  the 
ether  is  prevented  by  a  piece  of  oiled  silk  placed  over  the  surface 
immediately  after  the  application  of  the  collodion. 

Dental  Uses. — Cantharidal  collodion  is  a  valuable  application 
io  periodontitis,  applied  to  the  gum  over  the  root  of  the 
affected  tooth,  by  means  of  a  camel-hair  brush,  previously 
removing  all  moisture  from  the  surface,  and  protecting  the  lips 
and  cheeks,  until  the  ether  it  contains  has  evaporated,  and  an 
artificial  cuticle  is  formed.  The  blister  which  rises  on  the  gum 
should  be  punctured  with  a  needle.  The  counter-irritation  thus 
produced  relieves  the  periosteal  inflammation. 

Iodized  Collodion — Collodium  lodiduni — (collodion,  Sj, 
iodine,  gr.  xx),  forms  a  good  solution  of  iodine  for  external 
use. 

DENTAL    FORMUL/E. 
For  Odontalgia.  For  a  Styptic. 

R.    Acidi    carbolic!   cryst.,  R-    Collodii       ^^iij 

Collodii    .    ,  aa  .    .    .  ^j.  M.  Tinct.  ferri  perchloridi.  ^j 

SiGNA. — To  be  applied  on  cotton.  Olei  ricini gtt.'j.        M. 

SiGNA. — To  be  applied  to  the  bleeding 
For  a  Styptic.  surface,  or,  on  cotton,  to  the  alveolar 

R.    Collodii partes  lOO  cavity. 

Acidi  carbolici    .    .  partes    lo 

Acidi  tannici  .    .    .  partes       5  Por  a  Styptic. 

Acidi  benzoici     .    .partes      5.  M,      R.    Acidi  tannici, 
SiGNA. — To  be  applied  to  the  bleeding  Alcoholis, 

surface   by   means   of    a   camel-hair  ^theris  .    .  aa  .    .  partes  aeq.     M. 

brush.  Then   add   as  much   pyroxylin  as  the 

solution  will  dissolve. 

CONIUM— HEMLOCK. 

Derivation. — Hemlock  is  the  fruit  of  the  Conium  maculatum, 
or  spotted  (not  the  common)  hemlock,  which  is  an  umbellif- 
erous plant.  The  principal  one  of  its  three  alkaloids  is 
Conine,  CgHuN,  which  is  very  powerful. 

Medical  Properties  and  Action. — Conium  is  a  depressing 
agent  producing  motor  paralysis,  first  causing,  as  the  effects 
of  a  large  dose,  nausea  and  vomiting  with  a  general  weakness 
of  the  voluntary  muscles,  but  with  no  direct  action  on  the 
heart.     In  fatal  cases  of  poisoning  death  follows  from  paralysis 


322  DENTAL   MEDICINE. 


of  the  respiratory  muscles  causing  asphyxia.  The  antidotes 
are  nux  vomica,  picrotoxin,  and  active  muscular  exercise.  It 
is  quickly  decomposed  by  heat. 

Therapeutic  Uses. — Conium  is  employed  in  mania,  chorea, 
tetanus,  hydrophobia,  whooping-cough,  asthma,  laryngismus 
stridulus,  diseases  of  the  eye  and  strychnine  poison.  For 
nerve-pain  with  muscular  spasm,  the  best  results  may  be  ex- 
pected from  the  combined  administration  of  morphine  and 
Conine,  subcutaneously  applied,  as  the  effects  of  conine  are 
greatly  heightened  by  morphine.  Conium  is  also  used  in 
dislocations  to  relax  muscles. 

Dose. — Of  Abstractum  conii,  gr.  ss  to  gr.  ij ;  Extractum 
conii  alcoholicum,  gr.  ij  to  gr.  iv ;  Extractum  conii  fluidum, 
ITLij  to  Htv ;  Tinctura  conii,  HTLx  to  f5j ;  Conine,  tTL  yV  to  1Ttij. 

Dental  Uses. — Conium  is  employed  in  neuralgias,  locally 
applied ;  inflamed  dental  pulps ;  also  in  cases  of  artificial 
teeth  lodging  in  the  oesophagus,  to  produce  relaxation  of  the 
muscles. 

CREASOTUM— CREASOTE. 

Formida. — CgH-ioOg.     Sp.  gr.  1.071. 

Derivation. — Creasote  is  a  product  of  the  distillation  of  wood 
tar,  its  name  being  derived  from  the  Greek  xp^aQ,  "  flesh,"  and 
ocoz'f]<;,  "preserver,"  as  animal  substances,  when  saturated  with 
it,  are  preserved  from  putrefaction.  It  is  also  obtained  from 
crude  pyroligneous  acid. 

Creasote,  when  fresh  and  pure,  is  a  colorless,  oleaginous 
fluid,  with  a  strong,  empyreumatic  odor,  resembling  closely 
carbolic  acid,  and  a  caustic,  burning  taste.  After  exposure,  it 
has  a  yellowish  or  brownish  tinge.  Its  purity  may  be  tested 
by  strong  acetic  acid,  which  dissolves  the  creasote,  and  leaves 
behind  the  impurities  floating  above  the  creasote  solution.  It 
may  also  be  tested  by  dropping  it  on  paper,  when,  if  pure,  it 
will,  after  being  volatilized  by  heat,  leave  no  stain.  Creasote 
may  be  distinguished  from  carbolic  acid,  which  it  closely 
resembles  in  many  respects,  by  not  coagulating  collodion 
when  mixed  with  it,  and  by  not  imparting  a  blue  color  to 


CREASOTE.  323 


a  piece  of  pine  wood  dipped  first  into  an  alkaline  solution  of 
creasote,  and  then,  after  drying,  into  muriatic  acid. 

Medical  Properties  and  Action. — Creasote  is  stimulant, 
sedative,  rubefacient,  escharotic,  styptic  and  antiseptic.  It 
possesses  the  property  of  immediately  coagulating  albumen, 
and  to  this  property  is  ascribed  many  of  its  effects  on  the 
living  system.  In  large  doses  it  is  an  acro-narcotic  poison : 
but  in  small  doses,  it  is  styptic  and  astringent,  and  for  the 
latter  property  it  is  more  generally  administered  than  for 
any  other.  When  creasote  comes  in  contact  with  the  blood, 
the  latter  changes  from  a  bright  red  to  a  reddish-brown 
color,  with  small  spots  of  coagulated  albumen,  and  also 
becomes  thicker.  Applied  to  the  tongue,  it  causes  severe 
pain,  but  without  redness  or  tumefaction ;  it  also  causes  a 
strong  taste  of  smoke,  and  a  copious  flow  of  saliva.  When 
administered  internally  in  small  doses,  it  causes  a  sensation  of 
warmth  in  the  stomach,  and  exercises  a  decided  sedative  action. 
In  large  and  poisonous  doses  it  produces  profound  stupor, 
flushed  countenance,  fixed  eyes,  slow  and  labored  pulse,  irri- 
table stomach,  nausea,  vertigo,  but  has  no  effect,  such  as  dila- 
tation or  contraction,  on  the  pupils.  The  treatment  in  cases  of 
poisoning  by  creasote  consists  in  administering  albumen,  such 
as  white  of  eggs,  milk,  or  wheat  flour ;  also  the  administration 
of  ammonia  and  other  stimulants,  mustard,  emetics,  etc.  Death 
from  creasote  is  caused  by  its  coagulating  the  albumen  of  the 
blood,  and  preventing  its  circulation  through  the  arterial 
system. 

Therapeutic  Uses. — Creasote  is  administered  internally  for 
gastric  irritability  and  vomiting,  flatulence,  diarrhoea,  diabetes, 
haemoptysis,  pulmonary  consumption,  chronic  bronchitis,  epi- 
lepsy, neuralgia,  etc.  Externally,  it  is  applied  to  ulcers^ 
eruptions,  diseases  of  the  skin,  wounds,  hemorrhage  from 
wounds  or  leech  bites,  warts ;  also  in  putrid  sore  throat,  as  a 
gargle. 

Dose. — Of  creasote,  gtt.  j  or  gtt.  ij,  several  times  a  day,  cither 
in  mucilage,  in  the  proportion  of  half  a  fluid  ounce  to  a  drop 
of  the  creasote  ;  or  it  may  be  given  in  pill  form.    For  external 


324  DENTAL   MEDICINE. 


use,  from  gtt.  ij  to  gtt.  vj,  or  more  may  be  added  to  a  fluid 
ounce  of  water. 

Creasote  Water. — Aqucz   Creasoti  (creasote,  5j,  distilled 
water,  Oj).     Dose  of  creasote  water,  f5j  to  f5iv. 

Solidified  Creasote. — For  the  purpose  of  making  the^ 
application  of  creasote  to  the  teeth  more  convenient,  and  pre- 
venting the  effects  upon  the  mucous  membrane  of  the  mouth 
when  applying  it  to  carious  cavities  in  teeth,  a  gelatinous  solid- 
ity may  be  given  to  it  by  adding  lO  parts  of  collodion  to  15 
parts  of  creasote. 

Dental  Uses. — Creasote,  like  carbolic  acid,  is  a  valuable  agent 
in  dental  practice,  although  the  use  of  the  latter  has,  in  some 
respects,  superseded  that  of  the  former,  the  two  being  very 
similar  in  their  action,  with  some  advantages  in  the  case  of 
carbolic  acid.  Creasote  is  employed  for  the  relief  of  odontal- 
gia, obtunding  the  sensitiveness  of  dentine,  alveolar  abscess, 
periodontitis,  suppurating  pulps  of  teeth,  devitalizing  pulps 
of  teeth,  treatment  of  exposed  pulps  of  teeth,  mercurial,  and 
other  forms  of  stomatitis,  ulcers  of  the  mouth,  diseases  of  the 
gums  ;  as  a  styptic  for  hemorrhage  from  the  gums,  mucous 
membrane  and  leech  bites,  and  after  the  extraction  of  teeth. 
Creasote,  like  carbolic  acid,  has  a  peculiar  power  as  an  anti- 
septic, hence  it  is  a  valuable  application  in  cases  attended  with 
offensive  purulent  discharges.  It  promotes  the  growth  of 
healthy  granulations,  and  hastens  the  healing  of  wounds,  and 
arrests  the  process  of  suppuration.  When  applied  to  ulcerated 
surfaces,  it  should  be  repeated  as  pus  is  formed,  or  fungous 
growths  appear.  It  is  a  painful  escharotic  upon  mucous  mem- 
brane, with,  however,  a  soothing  reaction.  An  ointment — 
Ungitentuin  Creasoti — is  composed  of  creasote,  fSss,  lard,  §j, 
and  is  useful  in  cutaneous  affections. 

For  the  treatment  of  exposed  pulps  it  is  employed  either 
diluted  or  in  its  full  strength  ;  for  periodontitis  and  alveolar 
abscess,  in  its  full  strength,  or  in  combination  with  such  agents 
as  glycerine,  iodine,  etc. ;  also  in  devitalized  teeth,  and  as  an 
antiseptic  application  in  ulceration  of  the  mouth,  and  reces- 
sion of  gums  from  the  neck  of  the  teeth.     When  used  as  a 


CREASOTE.  SO 


ol^O 


styptic  after  the  extraction  of  teeth  it  is  applied  on  lint  or  cot- 
ton, with  pressure  ;  and  diluted  with  water,  it  is  employed  in 
the  treatment  of  caries  and  necrosis  of  the  maxillary  bones. 
To  dilute  it  for  injections  it  is  often  mixed  with  alcohol,  and 
the  strength  reduced  by  adding  water.  Mixed  with  an  equal 
quantity  of  oil  of  cloves  its  odor  and  taste  are  modified.  Cre- 
asote  is  also  employed  to  neutralize  any  acid  remaining  in  the 
cavity  of  a  tooth  about  to  be  filled,  and  to  harden  and  render 
imperishable  the  contents  of  the  dentinal  tubuli,  for  which 
purpose  it  is  applied  to  the  walls  of  the  cavity  on  a  pellet  of 
cotton.  Equal  quantities  by  bulk  of  creasote  and  oil  of  cloves 
are  applied  to  aching  teeth,  painful  gums,  ulcerous  surfaces, 
and  also  where  pulps  are  not  exposed ;  also  for  saturating 
cavities  before  the  insertion  of  fillings,  as  a  disinfectant  and 
coagulant. 

DENTAL   FORMULAE. 
For  Pulpitis.  For  Odontalgia. 

Garretson.  R-     Creasoti gij 

Morphinse  acetatis     .  gr.  xx.     M. 
SiGNA. — To  be  applied,  on  cotton,  to 


R.     Creasoti gtt-vj 

Tinct.  iodinii  .  .    .    .   zi  •  •. 

^■;  canous  cavity 

Liq.  plumb,  subacet  .  ^j 

Chloroformi 

Tinct.  opii  .    .  aa  .    .  5  ss.         M. 

SiGNA. — Apply   on   cotton   to   exposed 


For  Odontalgia, 
B .     Creasoti, 

Chloroformi, 


Liquidi  opii  .  .  aa  .    .   3  iij 
Tinctura  benzoini  .    .  ^j  M. 

For  Alveolar  Abscesses.  SiGNA.— To  be   applied  on  a  pellet  of 

cotton,  to  carious  cavity. 

R.     Creasoti,  „     r^J    ,  ,  ■ 

.  ...  .,  For  Odontalgia. 

Lmimenti  lodi,  partes  sequales.  M.      „       „ 

SiGNA. — To  be  used  as  an  injection.  Chloroformi 


For  Odontalgia. 


Morphinae  hydrochlo- 
ratis  .    .    .  aa  .    .    .  ^iij 

R.     Creasoti Jss  Tinctura  benzoini  .    .  gj.  M. 

Camphorse gr.  x.      M.      SiGNA. — To  be  applied,  on  a  pellet  of 

SiGNA. — To  be  applied,  on  a  pellet  of         cotton,  to  carious  cavity.     (See   for- 
cotton,  to  carious  cavity.  mulse  of  Carbolic  Acid.) 

GuiACOL  is  a  derivation  of  wood  creasote,  in  the  form  of  an 
oily  liquid  with  an  odor  of  cassia  and  resorcin. 

It  po.sscs.ses  the  active  principle  of  creasote,  and  the  power  to 


326  DENTAL  MEDICINE. 


destroy  microbes  in  the  human  mouth.  It  is  claimed  to  pos- 
sess the  same  therapeutic  value  as  creasote  and  to  be  a  better 
disinfectant,  especially  in  cases  of  decomposed  pulps.  "  Gui- 
acol  may  be  sealed  up  in  a  pulp  cavity  from  one  to  three 
months  or  more,  and  the  contents  be  found  perfectly  disin- 
fected." 

CRETA  PR^PARATA— PREPARED  CHALK. 
PRECIPITATED    CHALK,    CARBONATE   OF    LIME. 

Formula. — CaCOg. 

Derivation. — Prepared  chalk  is  obtained  by  freeing  chalk 
from  such  impurities  as  gritty  and  flinty  substances  and  solu- 
ble saline  matter,  by  elutriation,  and  afterward  drying  it.  It 
is  the  only  form  in  which  chalk  is  used  medicinally. 

Medical  Properties  and  Action. — Prepared  chalk  is  antacid, 
absorbent  and  astringent.  It  diminishes  the  secretion  of  the 
mucous  membrane,  and  at  the  same  time  acts  as  an  antacid  in 
correcting  any  acidity  present.  When  internally  administered 
for  a  considerable  time,  like  magnesia,  it  accumulates  in  the 
bowels  and  forms  intestinal  concretions  ;  hence  an  occasional 
aperient  is  necessary. 

Therapeutic  Uses. — Prepared  chalk  is  an  excellent  antacid 
in  diarrhoea  from  acidity,  in  acidity  attending  dyspepsia  and 
gout,  chronic  bronchitis  in  advanced  stages,  rachitis,  etc. 
Externally,  it  is  employed  in  the  treatment  of  ulcers,  burns, 
excoriations  and  skin  diseases.  It  moderately  stimulates 
ulcers  and  absorbs  the  discharge,  thus  preventing  them  from 
spreading. 

It  is  an  antidote  for  poisoning  by  oxalic  and  most  of  the 
vegetable  and  mineral  acids. 

Dose. — Of  prepared  chalk,  gr.  v  to  3j,  in  powder  or  sus- 
pended in  water  by  the  aid  of  mucilage  and  sugar 

Chalk  Mixture — Mistura  Cretcs — (prepared  chalk,  5ss  ; 
acacia  gr.  cxx ;  water,  fBiv)  is  often  combined  with  opiates 
and  astringents,  such  as  laudanum  and  tincture  of  kino,  or  of 
catechu,  in  the  treatment  of  diarrhoea.     Dose,  5j  to  Sss. 


PREPARED   CHALK. 


327 


D£7ital  Uses. — Prepared  chalk  is  used  in  dental  practice 
chiefly  for  its  antacid  property,  and  generally  as  an  ingredient 
of  dentifrices ;  it  is  also  employed  in  the  form  of  powder  as 
an  antacid  in  acidity  of  the  oral  fluids,  for  which  purpose  it  is 
rubbed  between  the  teeth  and  permitted  to  remain  during  the 
night ;  it  is  also  employed  to  obtund  the  sensitiveness  of 
dentine,  on  account  of  its  absorbent  and  antacid  properties ; 
for  such  a  purpose  it  should  be  applied  repeatedly,  for  several 
days,  to  the  sensitive  surface.  In  the  dental  laboratory  it  is 
used  as  a  polishing  powder  for  metal  and  plastic  work  ;  also 
for  polishing  the  surfaces  of  gold  fillings.  The  precipitated 
chalk  of  the  Pharmacopoeia  is  the  preparation  to  be  preferred, 
on  account  of  its  freedom  from  gritty  particles. 


DENTAL    FORMULA. 


Dentifrice  in  the  form  of  Troches. 


R. 


CretcC  preparatJE 
Sodii  boratis  (pul 
Saponis  Castil     ' 
Sacch.  albse         ' 
Ossis  sepise  * 

Olei  rosae  .  .  . 
Millefleurs  .  . 
Essentise  jasmin 


fb.iv 


Ib.iss 

R).iX 
gtt.xxx 

I) 


Mix  with  a  solution  of  gum  syrup. 

Dentifrice  in  the  form  of  Camphorated 
Paste, 

(Keller  Medicine  Co.) 

Pts.  by  Wt. 

B .    Magnes.  carb 2 

Glycerini i 

Potas.  chlorat 3 

Tr.  camphora I 

01.  gaultherise q.  s. 

Cretse  prxp q.  s. 

To  make  desired  number  of  parts. 

Syr.  simplic q.  s.  M. 

To  make  a  thick  paste. 


R. 


Dentifrice. 

(Am.  Dent.  Association.) 

Cretas  praeparatae Ibiij 

Pulv.  cinchonse Ibj 

Pulv.  radicis  iridis  .  .    .    .Ibj 
Pulv.  sacchari  albi    .    .    .  Ibiss 
Pulv.  saponis  cas  •    •    •    •  ^j 

Sodii  carb ,^j 

Olei  sassafras gtl.lxxx. 

Dentifrice. 

(Am.  Dent.  Association.) 


R. 


Cretae  praep.  .  .  . 
Pulv.  cinchonae .  . 
Pulv.  radicis  iridis . 
Pulv.  sacchari  albi 
Pulv.  saponis  cas  . 

Sodii  carb 

Glycerini 

Mellis q.  s 

And  form  into  a  paste. 

Dentifrice, 
Pulv.  radicis  iridis  . 
Cretae  pracparatce  . 

Sodii  carb 

Pulv.  cinchonae     .    , 
Pulv.  sacchari  albi 
Pulv.  myrrhae    .    .    . 
Pulv.  ossis  sepiae 

Otto  rosae 

With  rose  pink,  q.  s.  to  color. 


R 


tbss 


gtt.iv. 


328 


DENTAL  MEDICINE. 


Dentifrice  in  the  form  of  Glycerine 

Tablets. 

(Keller  Medicine  Co.) 

Pts.  by  Wt. 

R .    Solut.  magnes.  carb  ...  2 

"      sodii  bicarb    ...  I 

"      potas.  chlorat.  ...  3 

"      sapo.  cas.  albi  ...  6 

Glycerini i 

Cal.  carb lo 

01.  gaultheria, 

Cassias.  .    .    .  aa q.  s.  M. 

To  flavor. 


R. 


Dentifrice. 

Cretse  prsep 

Pulv.  radicis  iridis  . 
Pulv.  sacchari  albi  . 
Pulv.  cinnamon  .  . 
Pulv.  saponis  cas.  . 
Pulv.  myrrhse  .  .  . 
01.  gaultheriae ,  .    . 


gtt.x.   M. 


Dentifrice, 

(A.  W.  Harlan.) 

R .    Crete  prasparatae, 

Pulv.  radicis  iridis  .  aa  .  ^ij 

Pulv.  saponis  cas., 

Pulv.  sodii  biboratis  aa    ^  ss 

Pulv.  myrrhse ^ij 

Mellis  et  glycerini  .    .    .  q.  s. 

To  make  a  soft  paste. 

Color  rose  pink.     Perfume  to  suit. 

Dentifrice. 
(Chapin  a.  Harris.) 

R  .  Creta  praeparatae  .  .  .  .  ^  iv 
Pulv.  radicis  iridis  .  .  •  §iv 
Pulv.  cinnamon  .  .  .  .  ^iv 
Sodii  carbonatis  exsiccatae  g  ss 
Pulv.  sacchari  albi  .    .    •   ^j 

Olei  limonis gtt.  xv. 

Olei  Rosae gtt.  ij 

SiGNA. — Ingredients  to   be   thoroughly 
pulverized  and  well  mixed. 


Dentifrice . 
R .    Cretas  praeparatae  ....  floiss 
Pulv.  sodii  boratis, 
Pulv.  radicis  iridis  .  aa  .  R)ss 
Semen  cardamom   .    .    .  ^j 
Pulv.  sacchari  albi  .    .    .  R)ss 

Otto  rosas q.  s.     M. 

To  flavor. 

Dentifrice. 
(W.  D.  Miller.) 
R.    Precipitated  carbonate  of 


calcium    .    . 


gi"^ 


Cinchona  bark "5^^ 

Prepared  oyster  shell  .  .  ^  xv 

Powd.  myrrh S^^X 

"      cloves 3"j^ 

Oil  of  cinnamon  ....  gtt.  x  to  xv 
Mix  well. 

Dentifrice  in  the  form  of  a  Paste  for 

Compressible  Tubes. 

(Keller  Medicine  Co.) 

Pts.  by  Wt. 

R .    Magnes.  carbonat.  ...  2 

Sodii  bicarb 3 

Potas.  chlorat 5 

Calcii  carbonat  .    .    .    .20 

Sapo.  cas.  pulv 6 

Glycerini i 

Olei  gaultheriae, 

Olei  limonis    .    .  aa  .    .    q.  s. 

Syr.  simplic q.  s. 

SiGNA. — To  make  a  paste. 

For  Fetor  of  Breath. 
(Milliron.) 

R.    Sulphur  powd., 

Creta  prep.  pulv.  .  .  aa  .  ^j 
Spts.  rectificatus  .    .    .    ■  ^jss 

Aquae  distill §iij 

Peppermint q.  s.      M. 

SiGNA. — ^After  removal  of  all  calcic  de- 
posits, use  with  a  tooth-brush  morn- 
ing and  evening. 


CROTON-CHORAL   HYDRATE. 


329 


Dentifrice, 
(Dr.  Darby.) 
R  .    CretK  prxparatne  ....   5  ^iij 
Pulv.  radicis  iridis  .    .    .   3iv 
Pulv.  ossis  sepipe  .... 
Pulv.  sacchari  albi  .    .    . 
Saponis  castil  .    .    .    .  aa^j 

Sodoe  bicarb 5  ss 

Pulv.  cinchonce  flava  •    •   §j 

Cochineal 5J 

Olei  rosK gtt.  xx.  M. 

Dentifrice. 
(Rose.) 
R .    Cretae  praeparatse  .  .    .    .  3  xv 

Pulv.  saponis 3J 

Saccharin gr.  x 

Thymolis gr.  xv 

Camphorse gr.  xxx 

Vanillin gr.  v 

Olei  Rosse gtt.  vj.  M. 

Rub  the  camphor  and  thymol  together 
in  a  mortar,  and  warm  gently  so  as  to 
render  the  mixture  liquid ;  then  add 
the  chalk  in  small  portions  at  a  time, 
reserving  about  one  ounce ;  next  add 
the  other  ingredients,  the  perfumes 
being  first  separately  rubbed  with  the 
remainder  of  the  chalk. 


Dentifrice,  Antacid,  Tonic  and  Antiseptic 
R  .    Cret£B  prseparatje  .  .    .    .  ^  iv 
Quininse  disulph  .  .    .    .  gr.  iv 
Pulv.  ossis  sepise  .  .    .    .  3  iv 
Otto  rosse gtt.  iv.  M. 

Dentifrice. 
(Dr.  a.  W.  Harlan.) 

R  .    Cretae  praeparatae  .... 

Pulv.  radicis  iridis  .  aa  .   3  iij 

Resorcin ^j 

Saccharine gr.  v 

Pulv.  ossis  sepias  .  .    .    .  3J 

Olei  menthce  piperitas .  .  y(\v     M. 

SiGNA. — Use  on  a  brush  moistened  with 
tepid  water. 

Dentifrice. 
(Dr.  a.  W.  Harlan.) 

R  .    CretK  praeparataa .  .    .    .  .^  iij 
Sodium  fluo.  silicate  .    .  ,^  ss 

Acidi  tannici gr.  xxx 

Pulv.  sacchari  albi  .  .  .  ,^jss 
Pulv.  ossis  sepise  .  •.  .3  ss 
Olei  gaultheriae  ....  TTL^-     M. 

To   make   a  paste   of  the   above,  add 
glycerine  2  parts  and  honey  i  part. 


Dentifrices  may  be  pleasantly  flavored  with  wintergreen, 
cassia,  sassafras,  lemon,  peppermint,  anise,  lavender,  penny- 
royal, cloves,  calamus,  attar  of  roses,  oil  of  neroli,  etc. 


croton-chloral  hydrate. 

BUTYL-CHLORAL     HYDRATE. 

Formula. — C4H5CI3OH2O. 

Z)mz;«//^«— Croton-chloral  Hydrate  is  obtained  by  the 
action  of  chlorine  upon  aldehyde.  It  is  in  the  form  of  small, 
brilliant,  white,  silvery  crystals  of  a  sweetish  taste,  like  that  of 
melons.  It  is  slightly  soluble  in  water,  and  resembles  hydrate 
of  chloral  in  its  hypnotic  effects;  but  its  action  in  this  respect 
is  not  -so  powerful,  nor  so  certain.     It  differs  from  hydrate  of 


330  DENTAL   MEDICINE. 


chloral  in  the  singular  property  of  causing  anaesthesia  of  the 
head.  To  ^  relieve  pain  and  induce  sleep,  the  best  effects  are 
obtained  from  a  combination  of  the  two  agents. 

Medical  Properties  and  Actio?!. — It  is  a  sedative,  hypnotic 
and  anaesthetic.  It  resembles  chloral  hydrate,  but  is  not  so 
certain  in  its  effects  as  a  hypnotic.  Its  action  commences  in 
the  head  and  face. 

Therapeutic  Uses. — Croton-chloral  hydrate  is  highly  recom- 
mended in  dysmenorrhoea,  sciatica,  chronic  cough,  and  in 
neuralgia  as  an  anodyne.  One  or  two  grains  will  relieve 
severe  neuralgia  of  the  fifth  pair  of  nerves ;  it  is  frequently 
necessary,  however,  to  administer  from  five  to  fifteen  grains, 
but  it  is  not  safe  to  exceed  this  amount  at  one  time. 

Dose. — Of  croton-chloral  hydrate,  gr.  j  to  gr.  x ;  as  an 
anaesthetic,  gr,  xv,  dissolved  in  warm  water. 

Dental  Uses. — It  is  employed  with  effect  in  facial  neuralgia, 
in  doses  of  from  two  to  five  grains  every  hour  or  two,  until 
fifteen  grains  have  been  taken ;  also  as  a  sedative,  in  doses  of 
from  three  to  five  grains,  in  periodontitis,  pulpitis,  etc.,  etc. 

DENTAL    FORMULA. 
For  Neuralgic   Odontalgia. 

Von  Kirchbauer. 

R.     Croton  chloral ^j 

Glycerini ^vj 

Aquae  destill §  iiss 

Syr.  aurantii 5  iv 

Oleum  foeniculae g't.  vj.   M. 

SiGNA. — A  tablespoonful,  and  if  pain  continues  severe,  repeat  the  dose  in  an 
hour. 

CUPRI  SULPHAS— SULPHATE   OF   COPPER. 

BLUE   VITRIOL,  BLUE   STONE. 

Formula. — CuS04,5H20. 

Derivation. — Sulphate  of  Copper  is  obtained  by  roasting 
the  native  sulphuret,  or  by  the  combination  of  oxide  of  cop- 
per and  sulphuric  acid,  filtering  and  crystallizing.  It  is  in  the 
form  of  blue  prismatic  crystals  which,  after  exposure  to  the 
air,  efifloresce  to  a  slight  degree,  and  become  covered  with  a 
greenish-white  powder.     It  has  an  astringent,  metallic  taste. 


SULPHATE   OF   COPPER.  331 

Medical  Properties  and  Action. — Sulphate  of  Copper  is 
emetic,  tonic,  nervine,  stimulant  and  astringent,  and  is  quite 
soluble  in  water,  but  insoluble  in  alcohol.  It  is  a  prompt  and 
efficient  emetic,  the  emesis  commencing  a  few  minutes  after 
it  reaches  the  stomach,  and  the  copper  comes  up  with  the 
vomited  matter.  Little  or  no  depression  follows  its  adminis- 
tration as  an  emetic,  and  it  is  especially  adapted  to  cases  of 
narcotic  poisoning. 

Therapeutic  Uses. — Sulphate  of  Copper  is  employed  as  a 
prompt  and  efficient  emetic  in  cases  of  poisoning;  it  is  also 
administered  in  intermittent  fever,  neuralgia,  diarrhoea,  dysen- 
tery, croup,  epilepsy,  hysteria,  etc.,  etc.  Externally  it  is  ap- 
plied in  ulcerative  and  gangrenous  affections,  superficial 
hemorrhage,  leucorrhoea,  gonorrhoea,  ringworm,  purulent 
ophthalmia,  mucous  discharges,  diseases  of  the  skin,  indolent 
ulcers,  fungous  granulations,  warts,  etc. 

Dose. — Of  sulphate  of  copper  as  an  emetic,  gr.  iij  to  gr.  v; 
or  dissolve  20  grains  in  two  ounces  of  distilled  water  and 
give  a  tablespoonful  every  15  minutes  until  vomiting  oc- 
curs. For  internal  use  other  than  emetic  the  dose  is  gr.  \ 
to  gr.  ss.  in  pill. 

Dejital  Uses. — Sulphate  of  copper  is  employed  in  dental 
practice,  in  the  form  of  the  ammoniacal  solution,  for  long- 
standing cases  of  neuralgia ;  and  externally  it  is  applied  to 
ulcers  of  the  mouth,  cancrum  oris,  aphthous  ulceration, 
ulceration  of  the  gums  and  mucous  membrane  of  the  mouth, 
hemorrhage  from  leech  bites,  fungous  growths  of  the  gums, 
etc.,  etc. 

Dr.  Templeton  recommends  powdered  sulphate  of  copper 
for  suppurating  teeth,  applying  it  on  a  stick  of  wood  which  is 
wet  and  dipped  in  the  powder,  which  is  thus  thoroughly  ap- 
plied to  the  diseased  parts;  the  mouth  is  then  rinsed  with  tinct. 
of  gaultheria  or  tinct.  of  krameria. 


332  DENTAL   MEDICINE. 


DENTAL   FORMULAE, 

For    Cancrum  'Oris,  Aphtha   and    Gan-  For  Gangrenous    Ulcers   of  the   Mouth 

grenous  Affections  of  the  Mouth.  afid  Cancruin   Oris. 

R.     Cupri  sulph.  (powdered)  gr.  V  R.     Cupri   sulph ^ij 

Mellis §ss.    M.  Pulv.  cinchonse  .    .    .    .  §ss 

SiGNA. — Apply  as  a  lotion,  or  by  means  Aquae ^^  iv.    M. 

of  a  camel's  hair  brush.  Signa. — Bnish  over  ulcerated   surface 

twice  daily. 

For  Ulcerative  Stomatitis.  For  Caries  of  the  Maxillary  Bones. 

R.     Cupri  sulph gr.x  (Bartholow.) 

Pulv.  cinchonse 5  ij  R .     Cupri  sulph, 

Pulv.  gum  acacias  ,  .    .    .  gj  Zinci  chloridi  .    .  aa  .  partes  xv 

Mellis ^  ij  Liquor  plumbi  ....        "      xxx 

Aquse ^iij.  M.  Aquae  destillatse  ...       "     cc. 

SiGNA. — Apply,  by  means  of  a  camel's-  Signa. — To  be  applied  for  30  minutes 

hair  brush,  to  the  ulcerated  surface.  at  a  time. 

ERGOTA— ERGOT. 

Derivation. — Ergot  is  a  fungous  growth  which  replaces  the 
grain  of  the  common  rye.  It  is  bitter,  and  excites  heat  and 
dryness,  followed  by  pain  in  stomach,  thirst,  vomiting  and 
intestinal  pain  and  sometimes  purging.  Small  doses,  long 
continued,  cause  spasms  and  death  by  coma  and  asphyxia; 
gangrene  of  the  lower  extremities  may  follow  its  prolonged  use. 

Medical  Properties  ajid  Action. — Ergot  causes  contraction 
of  the  involuntary  muscular  fibre,  the  uterus,  and  smaller 
blood  vessels,  and  dilates  the  pupils.  It  is  employed  to  pro- 
duce contraction  of  the  uterus  in  child-birth.  It  is  also  ad- 
ministered in  chronic  diarrhoea,^  and  dysentery,  enlarged  heart 
without  valvular  lesion,  gonorrhoea,  acne  rosacea,  etc.,  etc. 
It  is  very  serviceable  in  the  hemorrhagic  diathesis  where  there 
is  a  want  of  tonicity  of  the  vessels ;  also  used  in  epistaxis, 
uterine,  renal,  and  intestinal  hemorrhage,  and  in  hsemoptysis ; 
bleeding  of  hemorrhoids,  etc. 

Dose. — Of  the  fluid  extract  for  internal  use,  fSss  to  ij ;  of 
the  wine  of  ergot,  5j  to  oss ;  of  the  aqueous  extract  dissolved 
in  water  the  hypodermic  dose  is  gr.^  to  gr.  iij. 

Dental  Uses. — Ergot  is  useful  in  the  treatment  of  hemor- 
rhage of  the  gums,  and  that  following  the  extraction  of  teeth 
when  it  is  excessive  and  persistent. 


ESSENTIAL   OILS.  333 


ESSENTIAL  OILS. 
The  volatile  or  essential  oils  are  compounds  of  carbon  and 
hydrogen,  and  differ  from  the  fixed  oils,  which  are  compounds 
of  carbon,  hydrogen  and  oxygen,  the  molecular  arrangements 
of  which  are  similar  to  the  metallic  salts  and  compound  ethers 
— possessing  the  radicals  of  certain  acids  united  with  hydro- 
carbons. The  essential  oils  are  generally  absorbers  of  oxygen, 
and  such  of  them  as  the  oils  of  peppermint,  cloves,  caraway, 
cajeput,  mustard  and  turpentine  are  useful  obtunders  of  hyper- 
sensitive dentine ;  and  some  are  also  efficient  germicides  and 
antiseptics.  From  experiments  noticed  by  Dr.  Harlan,  the 
essential  oils  are  not  miscible  with  water;  hence  when  they 
are  used  as  a  root-dressing  they  are  not  contaminated  or  dis- 
sipated by  the  saliva  or  the  mixed  fluids  of  the  mouth.  They 
are  capable  of  depositing  vaporizable  camphors  that  are  pow- 
erful disinfectants,  and  are  soluble  at  a  temperature  below  body 
heat.  They  are  good  menstrua  for  iodine  compounds,  and 
oily  dressings,  M^hen  not  too  tightly  confined  in  a  pulp-chamber, 
are  not  vitiated  like  substances  which  are  soluble  in  water. 
They  may  be  allowed  to  remain  for  longer  periods  in  the  roots 
of  teeth,  when  it  is  not  possible  to  fill  such  roots  at  once. 
When  an  oily  dressing  (such  as  oil  of  peppermint  or  oil  of 
cassia)  is  applied  in  a  root  canal,  after  the  removal  of  a  pulp 
by  extirpation  or  its  devitalization  by  arsenic,  it  acts  as  an  ano- 
dyne and  also  as  an  antiseptic,  preventing  the  formation  of 
mephitic  gases.  The  oily  dressings  may  be  pumped  through 
roots  and  fistulous  tracts  with  impunity,  and  will  not  clog 
delicate  canals.  The  solutions  of  the  essential  oils  are  all 
made  as  follows  (Dr.  Black) :  "An  excess  of  the  oil  is  mixed 
with  water  by  violent  shaking  continued  for  some  minutes.  It 
is  then  placed  in  the  incubating  oven,  where  the  temperature 
is  99°  F.,  for  twelve  hours.  It  is  then  again  violently  shaken 
and  returned  to  the  oven  for  another  twelve  hours,  twenty- 
four  hours  in  all.  It  is  then  carefully  filtered,  and  if  not  per- 
fectly clear  and  free  from  all  appearance  of  oil,  it  is  rcfiltcred 
until  it  is  clear.  The  filtrate  is  then  used  as  the  solution  of 
the  oil.  The  same  plan  is  used  in  making  saturated  solutions 
of  the  crystalline  substances." 


334  DENTAL   MEDICINE. 


The  prominent  essential  oils  are  those  of  cajeput,  cassia, 
cinnamon,  "cloves,  eugenol,  eucalyptol,  fennel,  mustard,  cara- 
way, peppermint,  sassafras,  turpentine,  thyme,  pennyroyal, 
valerian,  wintergreen.  In  dental  practice  the  oil  of  cassia 
diluted  with  a  bland  oil  like  that  of  wintergreen  is  a  valuable 
dressing  for  putrid  root  canals  and  abscesses.  Dr.  Black 
recommends  the  following  mixture  : 

^.  Carbolic  acid  (melted  crystals),  i  part ;  oil  of  cassia,  2 
parts ;  oil  of  wintergreen,  3  parts.  Mix  the  oils  and  add  the 
melted  crystals  of  carbolic  acid.  This  is  known  as  the  i,  2, 
3  mixture. 

Dr.  Black  also  says :  "  After  thorough  cleaning  with  the 
watery  form  of  the  antiseptic  we  need  something  that  will  be 
more  enduring  in  its  effects,  and  according  to  conditions 
should  choose  between  the  oils  and  the  powders.  If  it  is  an 
abscess  with  which  we  have  to  deal,  an  oil  which  is  in  itself  an 
antiseptic,  or  an  oil  holding  the  antiseptic  drug  in  solution  in 
effective  proportions,  may  be  introduced  into  the  cavity  and 
so  agitated  as  best  to  bring  it  in  contact  with  all  of  its  parts. 
This  will,  on  account  of  its  sparing  solubility,  remain  in  posi- 
tion very  much  longer  than  the  watery  forms,  and  the  essen- 
tial oils  are  very  much  more  diffusible  than  the  fixed  oils,  or, 
indeed  any  other  of  the  simple  forms  of  the  antiseptics  with 
which  I  am  yet  acquainted.  At  the  same  time  a  suflficient 
amount  for  very  extended  work  is  contained  in  small  compass. 
These  are  of  especial  value  in  such  positions  as  the  roots  of 
teeth.  In  this  position  any  but  the  most  irritating  of  the 
antiseptic  essential  oils  may  be  used  to  good  advantage,  and 
may  be  relied  upon  for  many  days  together.  In  the  choice  of 
the  essential  oils  it  is  by  no  means  necessary  that  the  most 
powerful  of  them  be. selected.  It  should  be  remembered  in 
making  the  choice  that  the  more  powerful  antiseptics  are  the 
more  irritating,  as  a  rule.  It  is  therefore  often  best  to  choose 
antiseptics  of  very  moderate  range,  especially  where  it  is  only 
required  to  preserve  a  condition  of  asepsis.  For  instance, 
when  a  very  foul  root  canal  is  opened  such  an  antiseptic  as 
the  oil  of  cassia  is  indicated.     After  appropriate  cleaning,  and 


ESSENTIAL  OILS.  335 


especially  in  case  cleaning  is  to  be  deferred  for  fear  of  forcing 
poisonous  material  through  the  apical  foramen,  it  may  be  used 
in  full  strength  ;  in  which  form  it  may  be  relied  upon  as  a  dis- 
infectant as  well.  But  afterward,  when  it  is  only  a  matter  of 
holding  an  aseptic  condition  during  the  healing  of  the  parts, 
an  antiseptic  of  shorter  range,  that  is  not  so  liable  to  injure 
the  tissues,  is  to  be  preferred.  For  this  purpose  the  eucalypti 
extract  in  substance  is  a  very  useful  agent.  Its  range  of 
actual  inhibition  is  very  short,  but  its  injurious  effects  on  the 
tissues  are  also  very  slight,  so  that  the  healing  process  may 
go  on  in  its  presence  without  hindrance.  Furthermore,  this 
oil  has  a  very  extended  range  of  restraining  influence  beyond 
its  range  of  actual  inhibition  that  is  undoubtedly  of  much  use. 
This  oil  may  be  exchanged  for  terpinol  where  a  little  more 
stimulating  effect  is  regarded  as  beneficial.  The  oil  of  cloves 
and  the  oil  of  cinnamon  seem  to  occupy  a  middle  ground  and 
may  be  made  useful  in  a  large  class  of  cases  if  the  others  are 
in  any  wise  distasteful  to  the  dentist  or  his  patient.  The  oil 
of  mustard,  though  a  good  antiseptic  of  short  range,  has  an 
irritant  action  that  limits  its  use.  Yet  in  cases  where  it  is  de- 
sirable to  arouse  the  tissues  from  a  state  of  inactivity  this 
action,  in  a  high  degree,  is  combined  with  the  antiseptic  prop- 
erty. It  is  also  one  of  the  most  diffusible  of  the  antiseptic 
oils  thus  far  studied. 

"  Any  of  these  oils  may  be  used  in  the  emulsion,  if,  for  any 
reason,  it  is  not  thought  well  to  use  the  oil  in  substance.  This 
form  is  especially  recommended  for  surfaces  of  suppurating 
wounds  and  the  washing  of  abscesses.  In  this  way  small 
quantities  of  the  oil  may  be  widely  diffused  and  left  in  a  multi- 
tude of  minute  globules  to  gradually  dissolve  where  it  is  most 
wanted,  forming  a  kind  of  connecting  link  between  the  true 
solutions  and  the  oils  in  substance.  For  this  purpose  a  little 
of  the  oil  selected  may  be  diffused  through  water  by  severe 
shaking,  or  better,  by  repeatedly  filling  and  violently  emptying 
the  syringe.  The  milky  emulsion  thus  formed  may  be  used 
in  the  same  manner  as  the  solution. 

"  I  have  said  that  all  antiseptics  are  poisons.     I  wish  to 


336  DENTAL   MEDICINE. 


emphasize  this  statement.  They  are  antiseptic  by  virtue  of 
their  power  of  restraining  hfe  forces ;  and  their  use  as  anti- 
septics is  permitted  only  by  shades  of  difference  in  the  action 
of  certain  poisons  toward  the  different  forms  of  hfe,  by  which 
they  affect  the  fungi  more  prominently  than  the  animal  tis- 
sues." 

ETHIDENE  DICHLORIDUM— DICHLORIDE  OF  ETHIDENE. 

Foj'mula. — C2H4CI2.     Sp.  gr.  1.225. 

Derivation. — Bichloride  of  Ethidene  is  obtained  in  the 
preparation  of  chloral,  from  the  waste  products,  and  is  very 
much  like  chloroform  in  appearance,  odor  and  taste.  It 
has  a  variable  boiling  point  of  about  115°  F.,  and  is  readily 
soluble  in  alcohol,  sparingly  soluble  in  water,  and  but  slight- 
ly soluble  in  chloroform.  It  is  inflammable,  but  less  so  than 
alcohol. 

Medical  Properties  and  Action. — Dichloride  of  ethidene  is  a 
general  anaesthetic,  and  is  said  to  occupy  an  intermediate  rank 
between  chloroform  and  ether.  It  reduces  the  action  of  the 
heart  to  a  less  degree  than  chloroform,  with,  however,  consid- 
erable depression  of  the  pulse. 

It  has  been  somewhat  employed  in  England,  where  it  is 
regarded  as  being  safer  than  chloroform  for  inhalation,  and 
requiring  less  quantity  to  produce  anaesthesia  than  ether. 

Methods  of  Administration. — It  is  recommended  to  admin- 
ister nitrous  oxide  until  the  patient  is  nearly  unconscious,  and 
then  to  add  the  vapor  of  ethidene.  The  effects  of  this  agent 
are  described  as  follows :  The  pupils  dilate,  and  at  the  same 
time  stertorous  breathing  commences ;  the  pulse  falls,  and 
should  be  carefully  watched,  and  insensibility  to  pain  con- 
tinues for  some  time  after  the  patient  becomes  conscious.  It 
is  also  claimed  for  this  agent  that  there  are  no  unpleasant 
after-effects,  the  patient  recovering  as  if  from  a  natural  sleep, 
with  a  clear  mind  and  a  distinct  utterance.  It  is  also  recom- 
mended to  combine  the  vapor  of  ethidene  with  that  of  nitrous 
oxide,  by  loosely  inserting  a  sponge  containing  half  an  ounce 
of  ethidene  in  the  nitrous  oxide  gas-inhaling  tube,  or  in  the 


BROMIDE  OF  ETHYL.  337 


rubber  supply-bag,  when  the  effect  is  said  to  be  more  profound 
and  agreeable  than  when  nitrous  oxide  alone  is  administered, 
with  no  nausea  and  but  little  lividity  of  the  lips.  It  is  also 
said  to  produce  relaxation  of  the  muscles  rather  than  rigidity, 
differing  in  this  respect  from  nitrous  oxide  gas. 

Bichloride  of  ethidene  is  also  employed  as  a  local  anes- 
thetic, in  the  same  manner  as  chloroform,  aconite,  etc.,  for  the 
relief  of  facial  neuralgia,  etc. 

It  has  not  been  introduced  to  any  extent  into  this  country. 

ETHYL  BROMIDUM— BROMIDE  OF  ETHYL. 
HYDROBROMIC  ETHER. 

Formula. — CjHjBr.     Sp.  gr.  1.420. 

Derivation. — Bromide  of  Ethyl  is  obtained  from  bromide 
of  potassium,  sulphuric  acid,  alcohol  and  water,  by  distilla- 
tion, and  is  re-distilled  by  chloride  of  calcium.  It  is  a  color- 
less and  very  volatile  liquid,  boiling  at  40°  C,  heavier  than 
water,  and  possesses  an  agreeable  ethereal  odor,  and  a 
pungent  taste,  strong  and  sweetish,  with  a  somewhat  burning 
after-taste.  It  is  readily  soluble  in  alcohol  and  ether,  and  but 
sparingly  soluble  in  water. 

Medical  Properties  and  Action. — Bromide  of  ethyl  is  con- 
sidered to  be  a  very  effective  and  pleasant  general  anaesthetic, 
but,  like  all  other  agents  of  this  class,  it  must  be  administered 
with  great  care,  and  a  pure  article  employed.  There  is  no 
doubt  but  that  it  is  pleasanter  to  inhale  than  chloroform,  ex- 
ceedingly rapid  in  producing  complete  unconsciousness,  and 
very  evanescent  in  its  action.  That  it  is  any  safer  than  some 
other  and  older  agents  of  this  class,  clinical  experience  has 
not  demonstrated,  as  several  deaths  occurred  in  a  very  limited 
number  of  the  administrations  attending  its  introduction. 
Bromide  of  ethyl  is  not  inflammable,  nor  caustic,  nor  even 
irritant,  in  this  respect  being  preferable  to  chloroform,  which 
is  very  caustic,  and  to  sulphuric  ether,  of  which  the  ingestion 
is  nearly  impossible.  Dr.  Isaac  Ott,  comparing  bromide  of 
ethyl  with  other  anaesthetics,  says :  (rt)  Chloroform  increases 
the  pulse,  then  slows  it  by  a  cardiac  inhibitory  stimulation ; 


'838  DENTAL   MEDICINE. 


ether  increases  the  pulse ;  nitrous  oxide  also  increases  it  by 
paralysis  of  cardiac  inhibitory  apparatus  ;  whilst  bromide  of 
ethyl  increases  the  pulse  by  an  action  on  the  heart  itself,  [b) 
Chloroform  reduces  the  blood  pressure  by  paralysis  of  the 
main  vaso-motor  centre,  and  cardiac  debility;  ether  greatly 
increases  it  and  keeps  it  increased ;  and  nitrous  oxide  also 
increases  it ;  bromide  of  ethyl  increases  it  either  by  a  stimula- 
tion of  the  spinal  or  peripheral  vaso  motor  system,  [c]  Chlo- 
roform increases,  and  then  decreases,  respiration  ;  nitrous  oxide 
reduces  it ;  bromide  of  ethyl  decreases  it  by  central  action." 
He  also  draws  the  following  conclusions:  '' i.  Bromide  of 
ethyl,  either  by  inhalation  or  subcutaneous  uses,  kills,  by  a 
toxic  action  on  the  centres  of  respiration.  2.  That  the  decrease 
offeree  and  frequency  of  the  heart  contributes  to  the  paralysis 
of  the  respiratory  centres.  3,  That  injections  of  ethyl  into 
the  jugular,  towards  the  heart,  kill,  by  cardiac  arrest,  probably 
due  to  an  action  on  the  cardiac  muscle.  4.  Bromide  of  ethyl, 
in  toxic  doses,  depresses  momentarily  the  frequency  of  the 
heart,  which  is  followed  by  a  subsequent  rise  to  a  normal  rate. 
5.  Bromide  of  ethyl,  in  toxic  doses,  depresses  the  arterial 
tension,  due,  in  major  part,  to  the  depressant  action  of  the 
drug  upon  the  heart,  and  in  a  minor  part,  to  a  partial  loss  of 
tone  of  either  the  spinal  vaso-motor  centres  of  the  peripheral 
vaso-motor  system.  6.  The  inhibitory  power  of  the  pneumo- 
gastric  is  not  paralyzed." 

Introduced  into  the  stomach,  bromide  of  ethyl  does  not 
produce  anaesthesia,  as  when  absorbed  by  the  respiratory  organs, 
and  does  not  increase  the  pulse  over  its  normal  heat ;  and  in 
the  second  stage,  causes  an  intermission  of  the  pulse  every 
second  b'eat. 

Administration. — Bromide  of  ethyl  is  best  administered  in  a 
folded  starched  napkin,  so  as  to  cover  the  face,  and  having 
inside  of  it  a  soft  linen  handkerchief.  On  the  linen  handker- 
chief one  measured  drachm  of  the  agent  should  be  poured, 
and  the  patient  directed  to  take  long,  deep  inspirations,  or, 
what  is  better,  to  make  prolonged  and  forced  expirations.  In 
two    minutes    from   the  time  of  administration   of    the  first 


BROMIDE  OF   ETHYL. 


339 


drachm,  a  second  should  be  given,  and  this  should  be  re- 
peated at  intervals  of  two  minutes.  Like  all  general  anes- 
thetics, however,  the  quantity  of  inhalation  differs  according 
to  the  susceptibility  of  the  patient.  One  drachm  (or  in  some 
cases  two  drachms  may  be  required,  according  to  the  suscep- 
tibihty  of  the  patient)  of  the  bromide  of  ethyl  will  generally, 
in  from  one  to  three  minutes,  produce  an  anaesthesia  as  pro- 
found as  that  produced  by  an  ounce  of  sulphuric  ether.  As 
it  produces  an  anaesthetic  effect  on  the  muscles  of  the  throat 
and  upper  parts  of  the  pharynx,  it  is  useful  for  operations  on 
the  mouth  and  throat. 

The  effect  of  an  anaesthetic,  however,  is  to  be  more  regarded 
than  the  mere  quantity  of  the  agent  poured  upon  a  napkin  or 
sponge,  as  the  degree  of  anaesthesia  should  be  governed,  in 
most  cases,  by  the  nature  of  the  operation  to  be  performed 
under  its  influence. 

Prof.  Chisholm  says :  "  I  have  found  the  action  of  bromide 
of  ethyl  so  very  evanescent  that  it  can  never  take  the  place  of 
either  chloroform  or  of  sulphuric  ether  for  any  surgical  opera- 
tion which  requires  some  time  for  its  performance;  but  for  all 
quick  work,  which  can  be  done  in  one  or  two  minutes,  the  use 
of  this  anaesthetic  agent  leaves  nothing  to  be  desired.  These 
really  magical  effects  must  be  obtained  from  the  first  inhala- 
tion, what  I  call  the  primary  anaesthesia.  If  the  operation  be 
protracted,  and  a  second  or  even  third  dose  of  the  bromide  of 
ethyl  be  inhaled,  and  I  find  nausea,  vomiting  and  heaviness  in 
all  respects  as  if  chloroform  or  ether  had  been  used — under 
this  repetition,  bromide  of  ethyl  loses  all  its  advantages." 

The  odor  of  bromide  of  ethyl  is  more  rapidly  removed,  and 
is  more  agreeable  than  that  of  sulphuric  ether,  and  its  effects 
more  rapid  than  even  those  of  chloroform,  as  it  is  eliminated 
by  respiration,  and  by  the  kidneys,  more  speedily  than  any 
other  general  anaesthetic  agent.  It  requires  excessive  quanti- 
ties to  affect  thQ  heart  and  respiration  to  any  great  degree. 
Having  no  caustic  action,  it  can  be  safely  applied  subcuta- 
neously,  and  also  to  the  external  auditory  meatus  and  to  the 
mucous  membrane.    It  evaporates  upon  the  skin  very  rapidly, 


340  DENTAL   MEDICINE. 


producing  a  very  sensible  feeling  of  cold.  As  a  rule,  its  general 
effects  are  as  follows :  Moderate  acceleration  of  the  pulse  and 
respiration ;  slight  excitement  or  talking,  and  seldom  any 
struggling ;  flushing  of  face ;  dilatation,  sometimes  preceded 
by  contraction  of  pupil ;  diaphoresis,  generally  profuse ;  com- 
plete anaesthesia  in  two  or  three  minutes ;  recovery  of  con- 
sciousness in  from  one  to  two  minutes  after  the  withdrawal  of 
the  anaesthetic  agent ;  no  after- vomiting. 

Any  specimen  of  bromide  of  ethyl  which  has  a  disagreeable 
odor,  or  which,  on  standing,  becomes  brown,  or  any  that  will 
explode  and  burn,  is  impure  and  should  not  be  employed  for 
inhalation.  A  common  impurity  is  bromoform,  produced  by 
the  action  of  bromine  and  caustic  potassa  on  alcohol  or  wood 
spirit.  Bromide  of  ethyl  possesses  properties  intermediate 
between  those  of  chloroform  and  ether.  As  a  local  anaes- 
thetic it  is  highly  spoken  of,  and,  owing  to  its  non-inflamma- 
bility, is  the  only  anaesthetic  which  can  be  used  in  connection 
with  the  actual  cautery.  Dr.  Byrd  strongly  recommends  an 
anaesthetic  mixture  of  bromide  of  ethyl  i  part,  chloroform  3 
parts  and  alcohol  4  parts,  a  drachm  of  which  is  poured  upon 
the  sponge  of  the  inhaler,  which  the  patient  is  allowed  to 
inhale  with  the  stopper  out,  after  which  the  stopper  is  re- 
placed and  the  full  strength  of  the  mixture  inhaled.  Gen- 
erally in  five  minutes  the  patient  is  fully  anaesthetized,  when 
the  stopper  may  be  taken  out  to  permit  a  greater  admix- 
ture of  air,  and  replaced  as  the  judgment  of  the  operator 
may  dictate.  This  mixture,  it  is  claimed,  is  safer  and  less 
disagreeable  in  its  effects  than  the  bromide  alone.  For  use  as 
a  local  anaesthetic,  the  bromide  of  ethyl  is  atomized  with  the 
"spray  apparatus,"  which  should  furnish  enough  of  the  liquid 
to  moisten  the  skin.  The  extremity  of  the  tube  should  be 
held  some  two  or  three  inches  from  the  surface  on  which 
the  spray  is  to  be  thrown.  Within  two  or  three  minutes 
after  its  first  application,  anaesthesia  of  the  part  occurs, 
which  is  shown  by  the  appearance  of  a  white  spot.  The 
formation  of  this  spot  may  be  hastened  by  superficially  punc- 
turing or  scratching  the  skin.      The  sensation  of  cold  thus 


EUCALYPTUS.  341 


produced  is  sometimes  disagreeable,  but  is  rarely  painful. 
The  skin,  or  even  the  thin  layer  of  the  subjacent  tissue, 
may  be  painlessly  incised  while  the  white  spot  lasts.  This 
anaesthetic  appears  to  be  very  well  adapted  for  short  opera- 
tions, requiring  simple  anaesthesia  and  not  complete  resolu- 
tion ;  hence  it  is  now  preferred  by  some,  for  the  extraction  of 
teeth,  to  either  chloroform  or  ether.  Internally,  bromide  of 
ethyl  has  lately  been  recommended  for  whooping  cough,  in 
the  form  of  a  solution  of  i  part  of  bromide  of  ethyl  in  200 
parts  of  water ;  also  in  angina  pectoris,  the  dose  being  one- 
half  to  two  ounces. 

Given  internally,  it  is  also  said  to  relieve  gastric  pain  with- 
out affecting  the  appetite.  Inhalations  readily  relieve  con- 
vulsive cough ;  and,  introduced  on  cotton  wool  into  the  ex- 
ternal meatus,  it  relieves  the  pain  of  otalgia,  without  causing 
any  irritation. 

EUCALYPTUS. 

Source. — Eucalyptus  is  obtained  from  the  eucalyptus  globu- 
lus, a  tree  of  large  size,  and  of  the  natural  order  Myrtacese, 
found  originally  in  Australia,  and  known  as  the  ''  Blue  Gum 
Tree."  These  trees  are  now  growing  in  the  southern  parts 
of  Europe  and  the  United  States,  and  northern  Africa,  and 
their  presence  is  thought  to  be  preventive  of  malaria.  The 
leaves,  which  are  ensiform,  of  a  grayish-green  color,  and 
parchment-like,  are  the  only  part  which  possesses  medicinal 
qualities.  They  have  a  pleasant,  aromatic  odor,  with  a  warm, 
bitter  and  somewhat  pungent  taste,  like  that  of  cubebs,  the 
fresh  being  more  active  than  the  dried  leaves.  Their  medi- 
cinal virtue  is  owing  to  a  volatile  oil — Oleum  Eucalypti — 
which  contains  three  principles,  called  eucalyptene,  turpene, 
and  cymol.  Tannic  acid,  and  a  peculiar  crystalline  fatty  acid, 
are  also  found  in  eucalyptus ;  but  eucalyptene  is  the  most  im- 
portant con.stituent. 

Medical  Properties  and  Action. — Eucalyptus  is  antiseptic, 
disinfectant,  sedative,  tonic,  diaphoretic  and  somewhat  astrin- 
gent. When  taken  into  the  mouth,  it  excites  a  flow  of  .saliva, 
and  leaves  a  hot,  pungent,  persistent  and  disagreeable  odor. 


342  DENTAL   MEDICINE. 


When  introduced  into  the  stomach,  it  causes  a  sensation  of 
warmth,  and  promotes  the  secretion  of  the  gastric  juice. 
Being  stomachic,  it  increases  the  appetite  and  the  digestive 
action,  with  increased  intestinal  secretion.  Large  doses  pro- 
duce offensive  eructations,  a  feeling  of  weight  and  tension  at 
the  epigastrium,  and  indigestion,  followed  by  diarrhoea,  and 
irritation  and  congestion  of  the  kidneys.  It  increases  the  ac- 
tion of  the  heart,  lessening  the  arterial  tension,  and  causes  a 
feverish  condition.  It  accelerates  the  respiratory  movements, 
and  although  it  induces  sleep  in  the  weak  and  anaemic,  it  has 
the  opposite  effect  on  the  strong  and  healthy.  The  secretions 
of  the  skin,  mucous  membrane  and  kidneys  are  increased  by 
it,  and  become  strongly  odorous,  owing  to  the  presence  of 
eucalyptol,  a  name  given  to  the  oil.  The  inhalation  of  large 
quantities  of  the  vapor  produces  effects  analogous  to  those  of 
the  agent  when  taken  in  substance,  and  the  essential  oil  is 
readily  diffusible  and  readily  impregnates  the  blood. 

Therapeutic  Uses. — While  the  internal  use  of  eucalyptus  is 
contra-indicated  in  inflammatory  conditions,  it  is  a  very  effi- 
cient remedy  in  atonic  dyspepsia ;  chronic,  gastric  and  intes- 
tinal catarrh,  cachectic  conditions,  flatulence,  palpitation  of  the 
heart,  hysteria,  chorea,  asthma,  catarrhal  broncho-pulmonary 
affections,  chronic  diseases  of  the  liver  and  bladder,  etc.  It  is 
also  employed  in  intermittent  fever,  and  during  convalescence 
from  remittent  fever.  Externally,  it  is  an  efficient  application 
to  chronic  forms  of  angina  and  tonsillitis,  to  foul  ulcers  and 
wounds,  etc. 

Dose. — Of  the  fluid  extract  of  eucalyptus,  5ss-5j ;  of  the 
tincture  of  eucalyptus — Tinctura  Eucalypti — f5ss  to  f5ij ;  of 
the  extract — Extractuin  Eucalypti — gr.  j  to  3j ;  of  eucalyptol, 
the  dose  is  TTLv  to  oss,  in  capsules  or  emulsion. 

Dental  Uses. — In  dental  practice,  the  decoction  of  the  leaves 
is  an  efficient  local  application  in  the  different  forms  of  stoma- 
titis, after  the  acute  stage  has  subsided.  The  tincture  and  the 
distilled  water  o{  eucalyptus,  or  fluid  extract,  are  used  as  dis- 
infectant applications  in  indolent  offensive  ulcers  of  the  mu- 
cous membrane  of  the  mouth,  stomatitis,  pharyngitis,  etc.    The 


EUCALYPTUS.  343 


tincture  of  eucalyptus  has  been  employed  with  advantage  to 
obtund  the  sensibility  of  dentine.  The  oil  of  eucalyptus, 
either  alone  or  combined  with  iodoform,  forms  one  of  the  most 
effective  antiseptics  in  use,  for  the  treatment  of  putrescent 
pulps  of  teeth,  alveolar  abscess,  of  the  chronic  form,  pyorrhoea 
alveolaris,  foul  ulcers  of  the  mouth,  etc. 

No  other  preparation  appears  to  prove  more  efficient  as  an 
antiseptic  than  the  combination  of  eucalyptus  oil  and  iodoform, 
in  the  treatment  of  suppurating  conditions,  putrescent  pulp- 
canals,  necrosis,  and  caries  of  the  bones  of  the  jaws,  etc.  The 
oil  can  be  introduced  as  an  injection,  with  an  abscess  syringe 
or  by  means  of  a  fine  broach  armed  with  cotton,  taking  care 
that  the  agent  is  carried  to  the  seat  of  the  disease,  and  the 
application  repeated  as  often  as  necessary.  It  may  also  be 
applied  by  dipping  a  pledget  of  cotton  in  the  oil  and  then  in 
finely  pulverized  iodoform  (Truman),  and  carried  to  the  tooth, 
as  in  cases  of  putrescent  pulps.  It  is  also  employed  as  a  local 
anc-Esthetic  for  odontalgia,  and  as  an  astringent  or  styptic 
in  superficial  hemorrhages,  mucous  discharges,  ulcerating 
mucous  membrane  of  the  mouth,  and  for  spongy,  ulcerating 
gums. 

Eucalyptus  has  a  solvent  effect  upon  gutta  percha,  a  fact 
which  should  be  remembered  when  using  it  in  connection 
with  temporary  fillings  of  the  former  material,  or  of  Hill's 
stopping. 

DENTAL   FORMULiE. 

For  Abscess  of  Antrum.  For  Root  Canals  as  an  Antiseptic. 

R.    Olei  eucalypti  .    .    .    .  ^ij  R.  D.  Pedley. 

Acidi  carbolici  .    .    .     gtt.x  oi.  eucalypti 2  parts 

Glycerini 5  ij  Ol.  caryoph 3  parts 

Olei  gaultheriae  .    .    .  ^ss.         M;  Creasoti    ....    .  10  parts  M. 

SiGNA.— Use  as  an  injection.  I„jq  ^^iK  dissolve    gum     mastich  to 

For  Suppurating  Pulps,  Ulcers,  etc.  saturation,    filter   through    cotton- 

R.    Olei  eucalypti    .    .    .    .  jj  wool   and  thoroughly  incorporate 

lodoformi gr-xv     M.  with  iodoform  in  a  mortar  until  it 

SiGNA. — Apply  as  an  injection,  by  means  becomes  a  solid  mass 

of  a  syringe;  or  on  cotton  wrapped  Signa. — Introduce  on  floss  silk  or  wisps 

on  the  end  of  a  fine  broach;  or  on  a  of  cotton,  and  cap  it  with  a  disk  of 

strand  of  floss-silk,  metal  and  insert  temporary  filling. 


344  DENTAL   MEDICINE. 


For  Abscess  of  Antrum.  For  Alveolar  Pyorrhcea. 

Geo.  L.  Parmele.  {Riggs  Disease.) 

^'     ^-':-y\- 3J  G.V.  BLACK. 

lodoformi gr.  x 

Aquae §j        M.  R.    Olei  eucalypti  .    .     .  HXxc 

SiGNA. — To  be  used  as  an  injection  in  Acidi  carbolici  .    .    .  TTLxc 

connection  with  a  tent   of  floss  silk  Olei  gaultherise  .        .  Tllxxx.    M. 

saturated  with  glycerine    and    euca-  SiGNA. — Apply  by  means  of  an  abscess 

lyptus.  syringe. 

FERRUM— IRON. 

Chemical  analysis  demonstrates  the  presence  of  iron  in  the 
blood,  the  gastric  juice,  chyle,  lymph,  bile,  milk,  urine  and  the 
pigment  of  the  eye ;  and,  although  metallic  iron  is  inert,  yet, 
when  it  reaches  the  stomach,  it  is  dissolved  by  the  acids,  and 
thus  acquires  molecular  activity.  By  its  oxidation  in  the 
stomach  hydrogen  is  set  free,  which  in  its  nascent  state  unites 
with  sulphur,  forming  sulphuretted  hydrogen. 

Medical  Properties  and  Action. — The  salts  of  iron  act  through 
and  upon  the  blood,  improving  its  quality  and  increasing  its 
quantity,  and  hence  they  are  termed  "  haematinic. "  These  salts 
of  iron  are  absorbed  into  the  system,  and  are  detected  in  the 
blood,  urine,  etc.,  and  under  their  use  the  appetite  increases, 
the  digestion  is  improved,  the  pulse  increases  in  frequency  and 
fullness,  the  health  becomes  better,  and  there  is  an  increase  in 
flesh  and  an  improvement  in  color  ;  hence  they  are  "  restora- 
tives." As  these  salts  of  iron  in  large  doses  cause  nausea  and 
vomiting,  being  irritant  poisons,  and  even  small  doses,  when 
administered  for  a  long  period,  exhaust  the  gastric  glands  by 
over-stimulation,  their  use  is  contra-indicated  in  a  plethoric 
condition,  especially  when  accompanied  with  a  hemorrhagic 
tendency,  or  when  there  is  an  atheromatous  state  of  the  cere- 
bral vessels.  Certain  of  these  salts,  such  as  the  sulphates,  the 
chlorides,  and  the  nitrates,  possess  a  high  degree  of  astrin- 
gency,  and  when  taken  internally  produce  constipation. 
Brought  in  contact  with  the  blood,  they  coagulate  it,  and 
solidify  the  albuminous  elements  of  the  tissues,  being  powerful 
"  haemostatics." 

Without  great  care  is  exercised  in  the  internal  administra- 


IRON.  345 

tion  of  iron,  owing  to  the  acidity  and  astringent  property  of 
many  of  these  preparations,  injury  results  to  the  teeth,  upon 
which  they  act  with  great  energy.  The  tincture  of  the  chlo- 
ride and  the  sulphate,  as  shown  by  the  experiments  of  Dr. 
Smith,  of  Edinburg,  Scotland,  are  more  corrosive  than  the 
wine  of  iron,  and  even  more  injurious  than  the  compounds  of 
iron  with  the  vegetable  acids.  The  use  of  an  alkaline  gargle 
of  carbonate  of  soda,  or  prepared  chalk,  or  solution  of  am- 
monia, before  and  after  the  taking  of  the  iron  preparation  into 
the  mouth,  and  the  subsequent  employment  of  an  antacid 
dentifrice,  will  obviate  the  injurious  effects  of  these  salts  of  iron 
upon  the  teeth.  While  the  carbonate  of  iron  in  the  form  of 
pill,  nor  the  reduced  iron,  are  injurious  to  the  teeth  by  direct 
action,  yet  eructations  of  hydrogen  compounds  produced  by 
their  ingestion  may  injure  the  teeth. 

The  use  of  a  tube  carried  well  back  in  the  mouth  and  the 
iron  preparation  well  diluted,  should  be  preceded  and  followed 
by  the  alkaline  solution.  The  preparation  known  as  dialysed 
iron — Ferrnni  Dialysatum — which  is  iron  in  the  colloid  state, 
made  by  the  process  of  diffusion,  is  odorless,  without  the 
styptic  taste  of  the  other  preparations,  and  does  not  discolor 
the  teeth,  being  free  from  irritant  action ;  neither  does  it  cause 
constipation,  and  hence  it  is  the  best  form  in  which  to  admin- 
ister iron.     The  dose  of  dialysed  iron  is  TItv  to  5j- 

Therapeutic  Uses  of  IroJt. — Iron  is  an  efficient  tonic,  and 
promotes  the  appetite  and  the  digestion ;  hence  it  is  employed 
in  anaemia,  chlorosis,  combined  with  quinine,  in  chronic  mala- 
rial affections ;  syphilitic  cachexia,  acute  rheumatism,  ery- 
sipelas, diphtheria,  scrofula,  rickets,  neuralgia  depending  on 
anaemia,  epilepsy  in  weak,  anaemic  subjects,  fatty  degenera- 
tion of  the  heart,  passive  forms  of  hemorrhage  due  to  anaemia, 
albuminuria,  etc.,  etc.  Externally,  the  styptic  preparations  of 
iron  are  employed  to  arrest  hemorrhage — hemorrhage  from 
leech  bites,  hemorrhage  following  the  extraction  of  teeth,  hem- 
orrhage resulting  from  wounds  and  surgical  operations,  etc.,  etc. 

[For  doses  of  the  various  preparations  of  iron,  see  "Table 
of  Doses."] 


346  DENTAL   MEDICINE. 


Chloride  of  Iron — Ferri  Chloridum — Perchloride  of  iron. 
Formula,  Fe2Clgi2H20.  Is  obtained  by  heating  iron  wire 
with  hydrochloric  acid,  and  afterwards  converting  the  ferrous 
chloride  thus  formed  into  ferric  chloride  by  heating  it  with 
hydrochloric  and  nitric  acids.  It  is  in  the  form  of  crystalline 
masses  of  an  orange  yellow  color,  inodorous  and  of  a  strong 
styptic  taste.  It  is  deliquescent  and  readily  soluble  in  water, 
alcohol  and  ether.  It  is  used  internally  in  the  form  of  a  tinc- 
ture— Tinctura  Ferri  Chloridi.     Dose,  TTLv-xx. 

Externally  the  chloride  of  iron  is  employed  as  a  styptic  and 
for  an  astringent,  for  the  latter  purpose  being  in  solution  of 
various  strength. 

Dental  Uses. — In  dental  practice  the  chloride  of  iron  is  used 
internally  for  the  treatment  of  neuralgia  when  it  is  attended 
with  anaemia ;  also  externally,  for  the  arrest  of  alveolar  hem- 
orrhage, although  the  preference  is  given  to  the  solution  or 
powder  of  the  subsulphate.  The  chloride  of  iron  may  be 
used  in  the  semi-deliquesced  or  crystallized  form,  or  in  solu- 
tion— Liquor  Ferri  Perchloridi — which  is  preferred  by  some  to 
the  crystallized.  To  bleeding  surfaces  it  is  applied  in  the 
proportion  of  5ss  to  5vj  to  the  ounce  of  water.  One  part  of 
the  chloride  gradually  added  to  six  parts  of  collodion,  in  the 
form  of  a  yellowish-red,  limpid  liquid,  makes  a  valuable  styp- 
tic. Chloride  of  iron  is  also  useful  as  an  application  to  fungous 
tumors. 

Reduced  Iron — Ferrum  Reductum — is  metallic  iron  in  the 
form  of  a  fine  powder,  obtained  by  the  reduction  of  ferric  oxide 
by  hydrogen.     Dose. — Gr.  j  to  gr.  v. 

Solution  of  Subsulphate  of  Iron — Liquor  Ferri  Subsul- 
phatis — Monsel's  Solution — is  composed  of  sulphate  of  iron, 
Sxij ;  sulphuric  acid,  oj,  and  gr.  xxx;  nitric  acid,  gr.  ccclx.  It 
is  of  a  syrupy  consistence  and  a  ruby  red  or  dark  brown 
color,  no  odor  or  acrid  taste,  but  possesses  powerful  astringent 
properties.  When  employed  for  the  arrest  of  alveolar  hemor- 
rhage from  tooth-extraction,  it  is  liable  to  cause  sloughing  of 
the  bleeding  tissues,  and  if  used  it  should  be  in  weak  solution, 
and  carefully  watched. 


IRON.  347 

Powdered  Subsulphate  of  Iron — Pulvis  Ferri  Subsul- 
phatis — Monsel's  Powder — is  in  the  form  of  a  yellow  powder, 
and  possesses  the  same  astringent  and  other  properties  as  the 
solution,  and  is  applied  as  a  styptic  in  alveolar  hemorrhage 
with  much  greater  convenience. 

Medical  Properties  and  Action. — Monsel's  solution  and  powder 
act  topically  as  powerful  astringents  and  mild  caustics,  and  are 
considered  to  be  among  the  best  styptics  in  use.  These  styp- 
tics combine  with  albumen  and  form  a  pale  yellow  compound, 
and  on  this  property  depends  their  chemical  action  on  the 
tissues  of  the  body.  Internally  administered  they  act  like  the 
sulphate  of  iron,  their  remote  effect  being  tonic  and  haemo- 
static. In  small  doses  they  exert  an  astringent  effect  on  the 
gastro-intestinal  mucous  membrane,  diminishing  the  quantity 
of  fluids  secreted  or  exhaled ;  hence  their  constant  use  will 
cause  constipation. 

Monsel's  preparations  of  iron  are  principally  used  externally 
for  hemorrhage  from  bleeding  vessels.  When  employed 
internally  it  is  for  the  arrest  of  hemorrhage  from  remote  organs. 

Therapeutic  Uses. — The  solution  and  powder  of  the  sub- 
sulphate  of  iron  are  used  internally  for  hemorrhage  from  the 
stomach  and  bowels.  Externally,  for  hemorrhage,  varicose 
ulcers,  etc.,  etc. 

Dose. — Of  the  solution  of  subsulphate  of  iron,  gtt.  v  to  gtt. 
x,  twice  a  day  in  some  bitter  infusion.  Of  the  powdered  sub- 
sulphate of  iron  the  dose  is  gr.  v  to  gr.  xv.  The  solution  is 
also  given  in  small  doses  with  the  sulphate  of  magnesia,  and 
as  an  artificial  chalybeate  purging  water. 

Dental  Uses. — In  dental  practice  Monsel's  solution  and 
powder  are  principally  employed  for  arresting  hemorrhage 
following  the  extraction  of  teeth,  hemorrhage  from  leech  bites, 
and  also  from  other  causes,  such  as  wounds  of  the  gums  and 
mucous  membrane,  in  the  treatment  of  ulcers  of  the  mouth  ; 
and  the  solution,  diluted  with  water,  forms  a  serviceable  ap- 
plication for  abraded  and  inflamed  mucous  surfaces. 

For  Hemorrhage  following  the  Extraction  of  Teeth. 
— After  carefully  cleansing  the  bleeding  cavity  as  thoroughly 


348  DENTAL   MEDICINE. 


as  possible,  the  styptic  should  be  applied  on  a  pellet  of  cotton, 
or,  in  case  the  powdered  subsulphate  of  iron  is  employed,  on 
a  pellet  of  cotton  previously  dipped  in  sandarach  varnish,  to 
which  the  powder  will  adhere,  and  inserted  over  the  mouth  of 
the  bleeding  vessel  at  the  apex  of  the  alveolar  cavity.  Cotton 
should  then  be  inserted  over  the  styptic  preparation,  and  the 
alveolar  cavity  be  thoroughly  filled  up.  If  necessary,  a  com- 
press, made  from  a  cork,  or  softened  modeling  composition, 
should  be  applied  over  the  cotton  filling  the  cavity  and  held 
in  place  by  the  opposing  teeth,  when  the  mouth  is  closed. 

DENTAL    FORMULA. 

For  Hemorrhage  frotn  Extraction  of  Teeth. 

Steere. 
R.     Liq.  ferri  persulph., 

Sodium  chlor aa partes  sequales.      M. 

SiGNA. — Apply  on  cotton  to  bleeding  cavity  and  secure  by  covering 
with  a  roll  of  cotton  cloth. 

For  Hemorrhage  after  Lancing  the  Gums  of  Children. 
Dr.  J.  W.  White. 
Where  oozing  of  blood  persists  in  spite  of  local  treatment : 

R .     Tinct  ferri  chloridi f  3  ss ; 

Acid.acetic  dil f  5J ' 

Liq.  ammonii  acet f  3J  > 

Ext.  ergot,  fid f  3  ij ; 

Syr.  simp f  §  ss ; 

Aquae  q.  s.  ad f  g  iij  M. 

S. — A  teaspoonful  every  3  hours  for  a  child  six  months  old. 

GELSEMIUM— YELLOW   JASMINE. 

Source. — Gelsemium  is  obtained  from  the  root  of  the  gel- 
semium  sempervirens — yellow  jasmine — woodbine,  belonging 
to  the  natural  order  Apocynacese,  which  grows  plentifully  in 
the  southern  United  States.  The  root  is  of  a  brownish  color 
externally,  and  a  grayish  color  within,  and  is  sold  in  small 
pieces,  from  one-half  to  two  inches  in  length,  and  a  quarter  of 
an  inch  in  thickness,  being  hard  and  slightly  cracked  longi- 
tudinally. It  has  a  bitter  taste,  and  an  aromatic  odor,  some- 
what like  that  of  green  tea. 


GELSEMIUM.  349 


Medical  Properties  and  Action. — Gelsemium  has  a  depress- 
ing and  sedative  influence  upon  the  nervous  centres,  and  dim- 
inishes the  force  and  frequency  of  the  heart's  action.  It  con- 
tains a  very  powerful  alkaloid,  gelseinia  or  gelscniina,  which 
is  colorless,  odorless,  with  an  intensely  bitter  taste 

Gelsemium,  in  moderate  doses,  causes  a  languid  feeling, 
attended  with  mental  calmness,  slow  action  of  the  heart,  droop- 
ing eyelids,  dilatation  of  the  pupil,  and  some  feebleness  of 
muscular  movements.  In  larger  doses  it  causes  vertigo, 
double  vision,  amblyopia,  paralysis  of  the  muscle  that  elevates 
the  upper  eyelid,  so  that  it  cannot  be  raised,  dilated  pupil, 
labored  respiration,  on  account  of  its  effect  upon  the  respira- 
tory muscles,  slow  and  feeble  movement  of  the  heart,  great 
muscular  weakness,  and  a  reduced  sensibility  to  pain  and 
touch.  Such  effects  occur  about  half  an  hour  after  the  gelsem- 
ium is  taken,  and  continue  for  two  or  three  hours,  when  they 
disappear. 

When  poisonous  doses  are  taken,  all  of  the  symptoms  de- 
scribed above  occur  in  a  more  intense  degree,  and  there  is  first 
an  unsteady  gait,  until  all  muscular  power  is  lost,  the  lower 
jaw  drops,  the  muscles  of  the  tongue  are  paralyzed,  speech 
being  impossible,  the  respirations  are  very  labored,  slight  and 
irregular,  and  the  action  of  the  heart  weak,  feeble  and  intermit- 
tent, and  generally  the  skin  is  covered  with  a  profuse  perspira- 
tion. Death  occurs  from  asphyxia,  but  consciousness  is 
preserved  until  near  the  end,  which  is  generally  calm,  and  not 
disturbed  by  convulsions. 

Therapeutic  Uses. — Gelsemium  is  internally  administered  in 
tetanus,  mania,  convulsive  or  spasmodic  cough,  such  as 
whooping  cough ;  pneumonia,  remittent  and  typho -malarial 
fevers,  ovarian  and  other  forms  of  neuralgia,  cerebro-spinal 
meningitis,  plcuritis,  etc.,  etc. 

Dose. — Of  the  fluid  extract  of  gelsemium — Extractuin  Gel- 
semii  Fluidum — the  only  officinal  preparation,  X(\y  to  ITLxv. 
Of  the  tincture  of  gelsemium — Tincttira  Gclsemii — (gelsemium 
5iv,  alcohol,  Oj),  the  dose  is  gtt.  x  to  gtt.  xx.  The  fluid 
extract  is  preferable   for  administration,  but  one  fluidrachm 


350  DENTAL  MEDICINE. 

of  this  has  caused  death.     Dose  of  the  alkaloid  gelsemia,  gr. 

^O'  ^^  S^'  To- 

Dental  Uses. — Gelsemium  is  greatly  extolled  as  a  remedy 

for  neuralgia  of  the  fifth  nerve,  often  affording  permanent  re- 
lief, especially  when  the  affection  is  associated  with  diseased 
teeth.  The  dose  may  be  repeated  at  any  time  after  an  hour 
and  a  half,  if  the  pain  is  not  relieved ;  a  third  dose  is  seldom 
required.  In  neuralgia  of  the  face  or  head,  three-minim  doses 
of  the  tincture  of  gelsemium  every  half-hour,  will  often  act 
very  beneficially,  and  leave  no  ill  effects.  Owing  to  the  toxic 
effects  of  this  drug,  care  is  necessary  that  the  dose  is  a  moder- 
ate one,  and  the  symptoms  carefully  observed. 

DENTAL   FORMUI.^. 
For  Neuralgia  from  Devitalized  Teeth. 

R .     Tinct.  gelsemii gtt.x 

Tinct.  aconiti gtt.v 

Aquas ^iv.     M. 

SiGNA. — One  teaspoonful  every  hour. 

For  Odontalgia,  Internal  Remedy. 
Dr.  Dunoycer. 

IJ.     Gelsemine i  milligramme; 

Aconitine  (cryst) ^  milligramme; 

Valerianate  of  quinine 5  centigrammes. 

For  one  pill. 

S. — Give  one  to  three  pills  to  an  adult  in  the  twenty-four  hours. 

GLYCERINUM— GLYCERIN. 

Formula. — C3H53HO.     Sp.gr.  1.25. 

Source. — Glycerin  is  obtained  from  the  saponification  of 
fats  and  fixed  oils,  and  contains  a  small  percentage  of  water. 
It  is  a  colorless,  inodorous,  syrupy  liquid,  of  a  sweet  taste, 
and  freely  soluble  in  water  and  alcohol,  but  not  in  ether  or 
chloroform. 

Medical  Properties  and  Action. —  Glycerin  is  nutrient  and 
emollient,  possessing  considerable  power  as  a  solvent  and  pre- 
servative. The  addition  of  ^,  yi,  or  even  Jg-  part  of  glycerin 
to  a  lotion  or  poultice,  or  an  external  application,  renders  it 
particularly  emollient  and  soothing.     It  keeps  the  parts  moist- 


GLYCERIN.  351 


ened  and  soft,  and  corrects  or  prevents  the  disagreeable  odor 
of  discharges,  and  it  does  not  evaporate  or  dry  at  an  ordinary 
temperature.  Glycerin  dissolves  carbolic  acid,  creasote,  tannic 
acid,  borax,  iodine,  quinine,  iodide  of  potassium,  gallic  acid, 
etc.,  and  its  uses  as  a  solvent  and  a  vehicle  for  other  remedies 
are  very  numerous.  It  has  been  prescribed  as  a  substitute 
for  cod-liver  oil,  where  the  latter  nauseates.  Officinal  solu- 
tions of  medicinal  agents  in  glycerin  are  known  as  glycerites 
[glyceriia). 

Therapeutic  Uses.  —  Glycerin  is  rarely  used  alone  as  an 
internal  remedy,  its  chief  use  being  external,  or  in  combination 
with  other  medicinal  substances.  It  has  been  prescribed  in 
phthisis,  diabetes,  acne ;  externally,  as  an  emollient  in  acute 
coryza,  chronic  follicular  pharyngitis,  chapped  hands  and  face, 
fissures,  skin  diseases,  dressing  for  wounds  and  ulcerated  sur- 
faces, and  as  a  vehicle  for  the  application  of  astringents  to  the 
eye ;  also  to  soften  cerumen  and  for  the  removal  of  insects  from 
the  ear,  and  for  diminishing  the  secretion  of  pus  ;  also  in  burns, 
abraded  surfaces,  erysipelas,  etc.  It  has  also  been  employed 
in  smallpox  as  an  emollient  and  to  prevent  pitting,  a  mixture 
of  one  part  of  glycerin  and  two  parts  of  rose  water  being  ap- 
plied, after  the  pustules  have  broken  and  the  discharge  has 
commenced  to  dry.  It  is  applied  for  a  few  days  until  the  scabs 
begin  to  loosen.  Glycerin  is  also  used  in  croup,  locally  applied 
to  the  glottis  ;  also  in  deafness,  where  the  auditory  canal  is  dry 
and  inelastic.  For  an  emollient  application  it  is  frequently 
combined  with  other  agents,  and  used  in  the  form  of  an  oint- 
ment or  embrocation.  Five  parts  of  glycerin  rubbed  up  in  a 
mortar  with  four  parts  of  yolk  of  tgg,  forms  a  compound 
which  prevents  the  action  of  the  air  on  irritated  broken  or 
abraded  surfaces,  and  is  soothing  in  erysipelas,  cutaneous 
affections,  etc.  Although  glycerin  is  so  bland  in  its  general 
character,  yet  it  produces  a  smarting  sensation  when  first 
applied  to  an  abraded  surface  of  the  skin ;  such  an  effect  is 
thought  to  be  due  to  the  affinity  of  glycerin  for  moisture, 
which  it  abstracts  from  the  skin  so  rapidly  as  to  cause  the 
smarting   sensation ;   mixing  the  glycerin  with  a  little  water 


352  DENTAL   MEDICINE. 


will  obviate  this.  Pure  glycerin,  when  mixed  with  water,  will 
raise  the  temperature  eight  or  ten  degrees,  and  hence  the  two 
should  be  combined  previous  to  the  application. 

Dose. — Of  glycerin,  5j  to  5ij. 

Dental  Uses. — Glycerin  is  a  useful  agent  in  dental  prac- 
tice as  a  solvent  and  emollient,  as  a  solvent  alone,  and  as  both 
solvent  and  emollient,  when  combined  with  other  substances. 

It  is  employed  with  great  benefit  in  such  diseases  of  the 
mucous  membrane  of  the  mouth,  as  the  different  forms  of 
stomatitis,  ulcers  of  the  mouth,  aphthae,  alveolar  abscess, 
abraded  surfaces  from  the  irritation  of  acrid  substances,  arti- 
ficial teeth,  etc. 

In  the  treatment  of  inflamed  and  ulcerated  conditions  of 
the  mucuous  membrane,  it  is  frequently  combined  with  borax, 
and  for  chronic  alveolar  abscess,  after  the  use  of  more 
active  agents,  and  diseases  of  mucous  membrane,  it  is  com- 
bined with  carbolic  acid,  iodine,  sulphite  of  soda,  etc.  As  an 
anodyne  and  emollient  application,  glycerin  is  combined  with 
morphine,  atropine,  acetate  of  lead,  etc.,  etc.  To  form  oint- 
ments and  embrocations,  it  is  combined  with  gum  tragacanth, 
lime  water,  oil  of  almonds,  rose  water,  etc.,  etc. 

DENTAL    FORMULAE. 

For  Chronic  Abscess,  Ulcerations,  etc.  For  Chronic  Alveolar  Abscess,    Ulcera- 
_  .  tion  of  Mucous  Membrane,  etc. 

R-     Glycerini gj  ^       Glycerini partem! 

Tinct.   iodi.    comp.    .    .  m^lv  ^^.^  ^^^^.^.   _    _    .  p^^es  2. 


Acidi  carbolici  cryst  .    .  TlXvj 
Aquae  destillatse  .    .    .    .  ^v. 
SiGNA. — Apply  as  a  lotion  or  injection 


For  Pulpitis. 
Aquae  destillatse.    .    •    •  gv.   M.       ^       Glycerini gtt.  ij 


Acidi  carbolici  .    .    .    .  gr.  v. 

Tr.  aconit.  rad., 
For  Inflammation  and  Ulceration  of  the  ^^_  ^^^^^    ^.^^  _  ^^  _  ^^^  .._ 

Mucous  Membrane.  »    •  ,•    ^ 

Acidi    tannici   .    .    .    .  gr.  j 

R.     Glycer.ni .  §j  Ol.  menth.  pip., 

Sodii  boratis ^ij  M.  qj_  caryophylli   .  aa  .  gtt.  xxv.  M. 

SiGNA. — Apply  as  a  lotion.  SiGNA. — Apply  on  cotton. 

For  a  Sedative  Application  in  Inflamed 
For  Aphthous   Ulceration  of  the  Mouth.  Mucous  Membrane. 

R.     Glycerini §j  R.     Glycerini 

Sodii  sulphitis 3J.  Chloroformi  .    .  aa  .    .  §ss      M. 

SiGNA. — Apply  as  a  lotion.  SiGNA. — Apply  as  a  lotion. 


HAMAMELIS.  353 


For  Pulp   Canals  of  Abscessed  Teeth. 
For  Aphthous  Sore  Mouth  of  Infants.  Faught 

R .     Glycerini,  R .     Glycerini f  5  ij 

Aquae  .    .    .  aa  .    .    .    .  ^ss  Acidi  tannic! ^ij 

Sodium   sulph    .    .    .  gr.  xxx    M.  Morphi?e   acetatis    .    .    .  5J 

SiGNA. — Use  on  swab,  every  2  hours.  lodoformi ^j.    M. 

SiGNA. — Apply  on  floss  silk  or  cotton. 

GLYCEROBORATE  OF   CALCIUM. 

Glyceroborate  of  Calcium  is  a  powerful  antiseptic,  and  is  pre- 
pared by  mixing  equal  parts  of  borate  of  calcium  and  glyce- 
rine, and  heating  the  mixture  to  about  160°,  with  constant  stir- 
ring, which  is  kept  up  until  a  drop  of  the  mixture  falling  from 
the  end  of  a  stirring-rod  upon  a  glass  plate  solidifies,  on  cool- 
ing, to  a  clear,  colorless,  brittle  bead  ;  the  mass  is  then  poured 
out,  and  after  cooling,  is  broken  up  and  the  fragments  at  once 
put  into  a  well-stoppered  and  dry  bottle.  It  is  soluble  in  all 
proportions  of  water,  and  on  exposure  to  the  air  will  rapidly 
become  liquid,  taking  up  its  weight  of  water.  Even  when  in 
a  very  dilute  solution  it  is  a  powerful  antiseptic,  with  no  odor 
and  no  poisonous  properties. 

GLYCEROBORATE  OF  SODIUM. 
Glyceroborate  of  Sodium  is  prepared  in  the  same  manner  as 
the  glyceroborate  of  calcium,  simply  substituting  the  borate  of 
sodium.  It  possesses  the  same  properties  as  the  glyceroborate 
of  calcium,  and  is  somewhat  preferable  to  the  latter,  as  even 
concentrated  solutions  of  the  glyceroborate  of  sodium  can  be 
applied  to  the  eye  without  inconvenience.  Both  preparations 
will  preserve  meat  for  a  long  time. 

HAMAMELIS. 
WITCH    HAZEL. 

Source. — Hamamelis  Virginica  is  an  indigenous  shrub,  com- 
mon to  all  parts  of  the  United  States  and  Canada,  and  usually 
found  in  stony  places  and  on  the  banks  of  streams.  The  bark 
and  leaves  are  the  medicinal  portions. 

Medical  Properties  and  Action. — It  is  tonic,  astringent,  seda- 
tive, and  anodyne.  The  bark  has  a  bitter,  astringent,  and 
23 


354  DENTAL  MEDICINE. 


somewhat  sweetish  and  pungent  taste,  and  was  first  employed 
by  the  Indians  as  a  sedative  and  discutient  application,  in 
painful  tumors  and  other  cases  of  superficial  inflammation. 
The  bark  contains  from  eight  to  ten  per  cent,  of  tannic  acid, 
and  also  a  bitter  principle. 

Therapeutic  Uses. — Hamamelis  Virginica,  although  not 
until  recently  officinal,  has  for  some  time  been  employed  in 
hemorrhage  of  the  lungs,  haematemesis,  and  in  phthisis. 
Externally,  it  is  applied  to  tumors,  inflamed  and  painful  parts, 
etc.,  etc.,  in  the  form  of  a  fluid  extract,  decoction  and  tincture. 
Two  minims  of  the  tincture  of  hamamelis  every  half  hour, 
will  often  control  hemorrhages  from  nose,  uterus,  and  from 
hemorrhoids. 

Dose. — Of  the  fluid  extract  of  hamamelis,  5ss  to  5ij ;  of  the 
decoction,  oss  to  Sj. 

Dental  Uses. — Hamamelis  is  employed  in  dental  practice  as 
a  sedative  or  anodyne  application,  in  incipient  periodontitis, 
in  the  form  of  the  fluid  extract,  applied  warm  on  lint  or 
cotton,  as  a  lotion ;  also  as  an  anodyne,  to  irritated  and  painful 
exposed  pulps  of  teeth ;  also  for  passive  hemorrhage  from  the 
mucous  membrane  of  the  mouth ;  also  for  the  soreness  arising 
from  the  removal  and  effects  of  salivary  calculus.  The  tinc- 
ture may  be  applied  as  a  sedative  lotion,  in  the  proportion  of 
one  part  to  ten  of  water. 

HYDRARGYRUM— MERCURY. 
QUICKSILVER. 

Formula. — Hg.     Sp.  gr.  13.5. 

Sources. — Mercury  is  a  metal  of  a  nearly  silver-white  color, 
and  a  very  high  degree  of  lustre.  It  is  liquid  at  all  ordinary 
temperatures,  and  only  solidifies  when  cooled  to  40°.  It  fuses 
at  39°  F.,  and  readily  volatilizes  at  66°  F. ;  it  boils  and  yields 
a  transparent,  colorless  vapor,  of  great  density.  It  also  volatil- 
izes somewhat  at  ordinary  temperatures,  and  especially  above 
68°  F.  The  ordinary  ore  from  which  metallic  mercury  is  ob- 
tained is  the  mercuric  sulphide,  although  it  is  occasionally  met 
with  in  globules  disseminated  through  this  native  sulphide, 


MERCURY.  355 


and  which  is  noted  as  cinnabar.  There  is  also  a  form  known 
as  horn  silver  or  native  calomel,  and  a  native  amalgam  of 
silver  and  mercury.  California  furnishes  metallic  mercury  of 
a  peculiar  purity,  in  large  quantities.  The  metal  is  obtained 
from  the  sulphide  by  the  process  of  "  roasting."  When  pure, 
metallic  mercury  does  not  readily  tarnish  in  the  air,  and  it  can 
be  purified  by  re-distillation,  or  by  adding  to  it  a  small  quan- 
tity of  a  strong  solution  of  nitrate  of  mercury. 

The  impurities  are  generally  dirt,  dust,  lead,  tin,  bismuth 
or  zinc. 

Dental  Uses. — Metallic  mercury  is  employed  in  dental  prac- 
tice, as  an  ingredient  of  amalgam  filling  material,  being  com- 
bined for  such  a  purpose  with  silver,  tin  and  zinc,  and  some- 
times with  gold  and  platinum,  in  addition  to  the  other  metals 
named. 

Hydrargyri  Chloridum  Corrosivum. — Corrosive  Chloride 
of  Mercury — Corrosive  Sublimate.  Mercury  Chloride,  Bichlo- 
ride of  Mercury.     Formula,  HgClg. 

Derivation. — Corrosive  sublimate  is  obtained  by  subliming 
a  mixture  of  chloride  of  sodium  and  mercuric  sulphate,  the 
latter  made  by  boiling  together  sulphuric  acid  and  mercury; 
double  decomposition  takes  place,  forming  mercuric  chloride 
and  sulphate  of  sodium.  Corrosive  sublimate  is  in  the  form 
of  colorless  crystals,  or  crystalline  masses,  which  are  inodor- 
ous, fusible  and  sublime  without  residue,  and  of  an  acrid,  styptic 
taste.  It  is  readily  soluble  in  15  parts  of  water,  7  parts  of 
alcohol  and  ether. 

Medical  Properties  and  Action. — It  is  one  of  the  most  active 
salts  of  mercury,  and  is  a  corrosive  poison,  but  the  therapeutic 
dose  now  used  is  less  liable  to  cause  the  disagreeable  and 
dangerous  effects  of  mercury  than  almost  any  other  preparation 
employed  for  the  same  purposes.  It  is  in  the  form  of  colorless 
crystals,  and  is  entirely  soluble  in  water.  Corrosive  sublimate 
is  an  effective  germicide  in  the  strength  of  one  part  to  2500 
parts  of  water,  being  250  times  more  powerful  than  carbolic 
acid.  An  aqueous  solution  of  i  in  20,000  destroys  the  spores 
of  bacilli  in  ten  minutes,  and  a  solution  of  1-5000  is  a  certain 


356  DENTAL   MEDICINE. 


disinfectant,  when  the  exposure  is  very  short,  and  it  is  now 
regarded  a:s  one  of  the  most  powerful  germicides  in  use  and 
is  very  extensively  employed  in  antiseptic  surgery. 

Dr.  F.  Abbott  regards  the  bichloride  of  mercury  as  being 
the  simplest  antiseptic  in  use.  Dr.  W.  D.  Miller,  of  Berlin, 
also  testifies  to  the  power  of  the  bichloride  as  an  antiseptic  in 
the  treatment  of  the  oral  cavity  as  follows :  "  The  experiments 
show  that  bichloride  of  mercury  is  about  two  hundred  times 
as  powerful  as  carbolic  acid,  and  demonstrate  very  clearly 
the  mistake  of  substituting  weak  solutions  of  this  antiseptic 
(i-iooo,  as  I  have  seen  recommended)  for  concentrated  car- 
bolic acid.  One  one-thousandth  is  only  one-fifth  as  powerful 
as  pure  carbolic  acid,  which  in  many  cases  may  be  used  with 
impunity.  It  is  consequently  useless  to  attempt  to  introduce 
the  sublimate  solution  for  the  purpose  of  sterilizing  root-canals, 
cavities  before  filling,  etc.,  unless  we  may  use  at  least  a  }^  per 
cent,  if  not  a  one  per  cent,  solution.  I  see  no  reason  why  this 
may  not  be  done.  In  a  few  cases  I  have  used  a  i  per  cent, 
solution  for  treating  root-canals,  and  do  not  hesitate,  partic- 
ularly vvith  the  rubber  dam  adjusted,  to  wipe  out  cavities  be- 
fore filling  with  a  two  per  cent,  solution,  and  see  no  possible  evil 
which  would  result  from  it."  "As  a  mouth  wash  I  have  fre- 
quently used  a  -^  per  cent,  (i.ooo)  solution  myself,  and  have 
seen  no  bad  results  from  it ;  I  would  not,  however,  recommend 
it  to  my  patients  in  this  strength. 

It  is  often  employed  in  solution  in  water,  i  part  to  2000, 
which  would  aproximate  i  grain  to  4}^  ounces  of  water. 

Dr.  Black  recommends  the  following  combination  :  Mercuric 
chloride,  gr.  ij ;  peroxide  of  hydrogen,  fSj.  M.  For  use  as  an 
injection  in  alveolar  abscess  and  the  pus  pockets  of  pyorrhoea 
alveolaris.  As  a  solution  of  bichloride  of  mercury  is  prone  to 
undergo  chemical  changes,  powders  or  tablets  containing  equal 
quantities  of  the  bichloride  and  ammonium  chloride  may  be 
prepared  and  a  solution  made  by  adding  one  of  these  to  an 
ounce  of  distilled  water. 

Another  method  is  to  take  one  drachm  each  of  the  bichloride 
and  hydrochloric  acid,  and  add  enough  of  distilled  water  to 


MERCURY.  357 


make  one  ounce,  which  forms  a  permanent  solution,  strong 
enough  in  the  proportion  of  a  teaspoonful  to  a  pint  of  water, 
to  make  a  sterilizing  and  disinfectant  solution  of  i  to  lOOO,  for 
washing  out  pus  sacs  and  pus  pockets  in  alveolar  abscess  and 
alveolar  pyrrhcea. 

Referring  to  the  bichloride  of  mercury,  benzoic  and  salicylic 
acids  and  listerine,  Dr.  Miller  says  :  Of  these  four,  which  are 
available  for  the  prophylactic  treatment  of  the  oral  cavity,  par- 
ticularly of  the  teeth,  the  bichloride  is,  without  doubt,  the  most 
effective,  because  its  action  continues  longer;  and  he  further 
says  :  "  Unfortunately  the  bichloride  of  mercury  possesses  one 
great  disadvantage  in  its  highly  poisonous  character.  It  seems, 
however,  scarcely  possible  that  any  harm  could  result  from 
its  use  in  so  dilute  a  form."  (See  Hydrargyri  Chloridum  Mite.) 

TJierapeiitic  Uses. — Corrosive  sublimate  is  alterative  in 
small  doses,  and  in  large  quantities  it  is  a  powerful  irritant 
poison,  corroding  the  stomach  and  causing  death  in  a  very 
few  hours.  Its  continued  use  has  caused  salivation,  but  it 
has  a  less  tendency  to  produce  such  an  effect  than  the  other 
preparations  of  mercury.  Internally  it  is  employed  in  second- 
ary syphilis,  chronic  diarrhoea  and  dysentery.  Externally  in 
diseases  of  the  eye,  diseases  of  the  skin,  ulcers,  gonorrhoea  and 
gleet,  etc.,  etc.  The  external  application  to  large  surfaces  is 
dangerous.  Its  use  is  contra-indicated  in  patients  affected 
with  pulmonary  disease.  Drs.  Yates  and  Kingsford  report 
three  cases  of  cancrum  oris  in  children  cured  by  wiping  the 
affected  parts  with  a  solution  of  the  bichloride  of  mercury  (l 
to  500)  and  afterwards  dressing  them  with  lint  soaked  in  a 
similar  solution  (i  to  1000).  Healthy  granulations  soon  made 
their  appearance  and  the  wound  quickly  contracted. 

For  cases  of  poisoning  the  antidotes  are  albumen,  white  of 
^^•g,  wheat  flour,  milk,  etc. 

Dose. — Of  corrosive  sublimate  gr.  ^^  to  gr.  y'jj,  in  pill  or 
solution. 

Dental  Uses. — It  is  employed  as  a  lotion,  injection  or  gar- 
gle, in  chronic  diseases  of  the  mucous  membrane,  ulcers, 
ulitis,  etc.      Dr.  C.  T.  Stockwell  reports  a  case  of  acute  ulitis 


358  DENTAL  MEDICINE. 


in  which  bichloride  of  mercury,  in  solution  i-iooo,  was  used 
to  bathe  the  parts,  and  the  pockets  about  the  teeth  injected  with 
it,  the  result  being  very  satisfactory ;  and  the  same  solution 
used  as  a  sterilizing  agent  is  considered  to  be  very  efficient. 

Test  for  Bichloride  of  Mercury. — Dr.  Chas.  Mayr  recom- 
mends the  following  to  determine  whether  a  solution  of  bi- 
chloride of  mercury  is  still  reliable  or  not;  Saturate  a  nice 
grade  of  paper  with  a  solution  of  a  given  amount  of  iodide  of 
potassium  in  water ;  with  the  proper  gauging  of  this  solution, 
after  it  has  dried  on  the  paper,  a  drop  of  the  solution  of  the  bi- 
chloride (i  to  5000)  will  produce  a  scarlet  spot  when  dropped 
on  the  paper ;  a  solution  of  i  to  1000,  a  yellow  spot;  a  more 
dilute  solution,  no  spot  at  all.  To  obtain  this  result,  a  certain 
strength  of  the  solution  of  iodide  of  potash  gauged  for  the 
paper  to  be  used  is  required.  The  solution  of  iodide  of  pot- 
ash should  be  made  slightly  alkaline  which  will  prevent,  to  a 
great  extent,  the  papers  from  turning  blue.  Diluting  a  solu- 
tion of  bichloride  of  mercury  with  lime  water  will  remove  the 
disagreeable  taste. 

For  Chronic  Alveolar  Pyorrhcea. 
A.  W.  Harlan. 

R.     Bichloride  of  mercury grs.  ij 

Tartaric  acid grs.  x 

Distilled  water f  ^  iv.  M, 

SiGNA. — First  cleanse  with  injections  of  peroxide  of  hydrogen, 
and  then  inject  the  above  with  a  hypodermic  syringe. 

Antiseptic  Solution. 
Emil  Rotter. 

R-     Corrosive  sublimate  ,  I  to  20,ocx) gr.  j- 

Sodii  chlorid gr.  vss. 

Acid,  carbolic gr.xxx 

Zinci  chlorid 

Zinci  carbolat aa.^]  ^. 

Acid,  boric gr.xl 

Acid,  salicylic gr.x 

Thymoli Kt^ij. 

Acid,  citric gr.ij 

Aquae q.  s.  ad  1,000,00.  M. 

Said  to  be  powerful,  yet  not  toxic  to  any  dangerous  extent, 
and  to  have  a  more  potent  effect  on  pyrogenic  microbes  than 
sublimate  in  solutions  of  I  to  1000.  If  a  weak  solution  is 
desired  the  sublimate  and  carbolic  acid  may  be  omitted. 


MERCURY.  359 


Antiseptic  and  Stimulant  Mouth  Wash. 

For  use  especially  in  Alveolar  Pyorrhoea. 

Dr.  Chas.  B.  Atkinson. 

R.     Hydrarg.  bichlor gr.ij 

Tinct.  Calendulae ^iv 

Aquae  dest.  q.  s. ;  ad §^"j-     ^• 

S.  Use  daily. 

To  Disinfect  Softened  Dentine  in  Cavities. 
Dr.  a.  W.  Harlan. 

R,     Corrosive  Sublimate gr-  ij 

Peroxide  of  hydrogen ^j 

Tartaric  acid X({y.     M. 

Aqueous  solutions  of  Labarraque's  solution,  permangan- 
ate of  potash  or  boro-glycerine,  may  also  answer. 

Prof.  W.  D.  Miller,  of  Berlin,  in  a  list  of  remedies  with  which  he  made  care- 
ful experiments,  places  the  relative  powers  of  well-known  agents  in  preventing  the 
development  of  fungi  as  follows  : 

Bichloride  of  mercury 

Peroxide  of  hydrogen I-  50.000 

Iodine I-     6,000 

Iodoform 

Salicylic   acid 

Eucalyptus 

Carbolic   acid 

Chloride  of  zinc 

Permanganate  of  potash 

Listerine 


5,000 
2,000 
1,600 
1,500 
1.250 
1,000 
120 


Hydrargyri  Chloridum  Mite — Mild  Chloride  of  Mercury. 
Calomel.     Meratroiis  Chloride.     Formtda,  HgCl. 

Derivation. — Calomel  is  obtained  by  subliming  a  mixture  of 
mercurous  sulphate  and  chloride  of  sodium,  a  double  decom- 
position taking  place,  by  which  mercurous  chloride  and  sul- 
phate of  sodium  are  formed.  The  mercurous  sulphate  thus 
employed  is  obtained  by  boiling  mercury  in  sulphuric  acid 
.and  triturating  the  resulting  mercuric  sulphate  with  mercury. 

To  remove  any  corrosive  sublimate  which  the  calomel  may 
contain,  it  is  washed  with  hot  distilled  water  until  the  ab- 
sence of  a  white  precipitate  with  ammonia  shows  that  the 
poisonous  ingredient  has  been  removed.  Calomel  is  in  the 
form  of  a  white,  inodorous,  tasteless   powder,  insoluble  in 


360  DENTAL  MEDICINE. 


water,  alcohol  and  ether,  and  wholly  volatilized  by  heat. 
Calomel  is,  incompatible  with  the  alkalies,  and  alkaline  earths 
and  alkaline  carbonates,  with  lead,  copper  and  iron.  When 
nitro-muriatic  acid  is  combined  with  it,  corrosive  sublimate  is 
formed;  neither  should  it  be  given  in  combination  with 
iodine. 

Medical  Properties  and  Action. — Calomel  and  the  other 
mercurials  are  employed  as  alteratives,  sialagogues,  purga- 
tives, diuretics,  etc.,  and  moderate  doses  increase  the  action 
of  the  secreting  glands  and  organs,  stimulating  the  salivary 
glands  in  a  very  decided  manner.  When  large  doses  are  ad- 
ministered the  effects  are  manifested  on  the  gums,  which  be- 
come tender  and  swollen,  the  salivary  glands  take  on  in- 
creased action,  the  saliva  and  buccal  mucus  flow  profusely, 
the  mucous  membrane  of  the  mouth  becomes  inflamed  and 
ulcerated,  the  tongue  swollen  and  the  breath  fetid,  with  a  me- 
tallic, copper  taste,  and  the  teeth  become  loose ;  such  symp- 
toms constitute  the  condition  known  as  salivation.  When 
the  use  of  the  drug  is  discontinued  these  symptoms  disap- 
pear, but  the  mucous  membrane  and  gums  are  ever  after 
more  susceptible  to  irritation,  and  the  stability  of  the  teeth  is 
more  or  less  impaired,  as  is  shown  by  the  recession  of  the 
gums  and  the  absorption  of  the  alveolar  processes.  In  many 
cases  the  gums,  especially  about  the  necks  of  the  teeth,  re- 
main somewhat, tumefied,  with  a  tendency  to  ulceration. 

If  the  use  of  the  mercury  is  continued  beyond  the  stage 
which  the  symptoms  just  described  indicate,  or  even  as  the 
effects  of  small  doses  in  persons  very  susceptible  to  the 
influence  of  mercury,  an  excessive  salivation  ensues,  with 
serious  ulceration  of  the  gums  and  mucous  membrane  of  the 
mouth,  loss  of  the  teeth,  and  even  necrosis  of  the  bones  of  the 
jaws.  Mercury  has  also  the  effect  of  causing  considerable 
emaciation,  from  the  absorption  of  fat,  and  sometimes  a  peculiar 
febrile  state  known  as  mercurial  fever;  and  also  diarrhoea, 
skin  diseases,  rheumatism,  neuralgia  and  disorder  of  nervous 
system.  Mercury,  after  it  is  absorbed,  has  a  decided  effect 
upon  the  blood,  which  it  impoverishes,  destroying  the  red 


MERCURY.  361 

blood  globules  (hematine  and  globuline) ;  the  blood  contains 
more  water,  is  more  prone  to  putrefaction,  and  the  unnatural 
fluidity  predisposes  to  hemorrhage,  which  may  become 
dangerous. 

Therapeutic  Uses. — Mercury  in  the  form  of  calomel,  blue 
mass  [Pihdce  Hydrargyri — pills  of  mercury — mercury  5ij; 
confection  of  rose  Siij,  and  powdered  liquorice  root  Sj,)  are 
employed  as  sialagogues,  indirect  tonics  and  cholagogues,  and 
purgatives  in  syphilis,  diseases  of  the  skin,  bilious  derange- 
ments, dyspepsia,  acute  glandular  affections,  diarrhoea  and 
dysentery  of  infants,  hepatic  disorders,  croup  and  membranous 
laryngitis,  cholera,  etc.,  etc. 

Dose. — Of  calomel,  gr.  ^5"  to  gr.  x ;  of  blue  pills,  or 
mass,  gr.  ss  to  gr.  xv.  Mercurials  are  administered  by  the 
mouth,  by  inunction,  by  fumigation,  and  by  the  hypodermic 
method. 

Mercurial  Ointment — Ungiientum  Hydrargyri.  Blue  oint- 
ment is  made  by  rubbing  two  parts  of  mercury  with  one  part 
of  suet  and  lard  each,  until  the  globules  disappear.  When 
rubbed  into  the  skin,  it  produces  the  constitutional  effects  of 
mercury,  and  is  applied  to  tumors,  syphilitic  sores,  blistered 
surfaces,  and  is  used  to  destroy  pediculi,  and  also  to  prevent 
pitting  in  small-pox. 

Mercury  with  Chalk — Hydrargyrum  cum  Creta,  a  gray 
powder,  consists  of  mercury,  three  parts,  prepared  chalk,  five 
parts.  It  is  a  gentle  laxative,  when  given  in  full  doses,  and 
is  antacid,  and  employed  chiefly  as  an  alterative  in  infantile 
diarrhoea,  etc. 

Dose. — Of  mercury  with  chalk,  for  adults,  gr.  v  to  xx;  for 
children,  gr.  ss  to  ij,  iij  or  x. 

The  effect  of  mercurial  preparations  upon  children  is  some- 
times very  serious,  as  a  profuse,  or  even  gentle  salivation  will, 
at  times,  cause  mortification  and  destruction  of  the  bones  of 
the  jaw,  the  teeth,  the  cheek,  and  lip ;  and  although  such  cases 
may  not  be  common,  yet,  to  avoid  such  a  powerful  action,  the 
gums  should  be  frequently  and  carefully  examined,  when  a 
course  of  such  remedies  is  being  pursued. 


362  DENTAL  MEDICINE. 


Protiodide  of  Mercury — Hydrargyrum  lodidtim  Viride, 
known  also,  as  Green  Iodide  of  Mercury — is  prepared  by- 
rubbing  mercury  and  iodine  together  with  the  addition  of  a 
little  alcohol.  The  formula  is  Hgl,  and  it  is  in  the  form  of  a 
greenish-yellow  powder,  insoluble  in  water  and  alcohol,  but 
soluble  in  ether.  Exposure  to  the  light  partially  decomposes 
it,  when  it  becomes  of  a  dark  olive  color. 

Protiodide  of  mercury  is  internally  administered  in  scrofula 
and  scrofulous  syphilis.  It  exercises  a  specific  influence  over 
the  lymphatic  and  glandular  system.  It  should  never  be 
given  at  the  same  time  as  iodide  of  potassium,  as  it  converts 
it  into  biniodide  and  metallic  mercury. 

Dose. — Gr.  i  to  j. 

Externally,  protiodide  of  mercury  is  applied,  in  the  form  of 
ointment,  to  syphilitic  ulcers,  acne,  pityriasis,  etc.,  etc. 

Biniodide  of  Mercury — Hydrargyri  lodidum  Rubrum. — 
Red  Iodide  of  Mercury.  Mercuric  Iodide.  A  red  powder 
which  becomes  yellow  when  heated  and  red  again  when  cold. 
It  is  wholly  volatilized  by  heat,  and  condenses  in  scales,  which 
are  first  yellow,  but  afterwards  red.  It  is  insoluble  in  water, 
but  soluble  in  boiling  alcohol  and  solutions  of  iodide  of  potas- 
sium and  chloride  of  sodium.     Poisonous. 

Dose. — Gr.  -^  to  -j^.     It  is  a  powerful  germicide. 

Red  Sulphuret  of  Mercury — Hydrargyri  Sidphidum  Rub- 
rum. — Vermilion.  Cinnabar.  In  brilliant  crystalline  masses 
of  a  deep-red  color  and  fibrous  texture.  It  is  entirely  volati- 
lized by  heat.  It  is  not  soluble  in  either  nitric  or  muriatic  acid, 
but  a  mixture  of  the  two  acids  will  dissolve  it.  Cases  have  been 
cited  in  support  of  the  asserted  poisonous  effects  of  vermilion, 
where  it  has  been  used  as  a  coloring-matter  for  dental  vulcanite, 
but  a  careful  analysis  as  well  as  evidence  based  upon  scientific 
investigation,  fails  to  establish  the  truth  of  such  a  theory. 
Vulcanite  composed  only  of  pure  caoutchouc  and  sulphur, 
known  as  "  black  vulcanite,"  possesses  advantages  over  the  red 
vulcanite,  in  being  of  finer  texture,  more  dense,  and  less  spongy, 
and  consequently  less  liable  to  absorb  and  retain  the  secretions 
of  the  mouth,  in  the  case  of  an  artificial  denture  constructed  of  it. 


IODOFORM.  363 


DENTAL    FORMULA. 

For  Diarrhcea  »f  Dentition.  For  Venereal  Sore  Mouth  and  Throat. 

R .    Calomel gr.ij  ad  vj  R  ■     Hydrar.  chlor.  corrosi  .  gr.j 

Cretje  ppt gr.xviij  Mellis  despumati  .    .    .    .  f  g  ss 

Ipecacuanhas  pulv    .    .  gr.ij  Aquae  destillatoe  .    .    .    .  f  §  iv.  M. 

Extract  hyoscyami    .    .  gr.iij   ad  vj  Signa. — To  be  used  as  a  gargle. 
F.  chart,  No.  vj. 
SiGNA.— One  every  two  or  three  hours,  ^^^  Warts,  Condylomata,  etc. 

according  to  circumstances.  R .     Hydrar.  chlor.  corrosi  .    gj 

Collodii ^j.  Solve. 

For  Febrile  Excitement  of  Dentition.  c^xt.       t^      u  v   j 

■'  SiGNA. —  io   be   applied   as  a   caustic, 

R.    Calomel gr.ij  ad  iij  with  a  camel's-hair  brush. 

Magnes.  calc gr.xxiv 

Ipecacuanha  pulv  .    .    .  gr.ij  to  iij  ^^^  Diarrhcea  of  Teething  Children. 

F.  ch.  No.  xij.  R.     Hydrargyri  cum  cretse, 

SiGNA.— One   to  be  given   every  three  ^"1^-  iP^cac.  et  opii  aa  gr.  j.       M. 

hours.  Signa. — One  powder. 

lODOFORMUM— IODOFORM. 
TERIODIDE    OF    FORMYL. 

Formula .  — C  H I3. 

Derivation. — Iodoform  is  a  preparation  of  iodine,  being 
obtained  by  the  action  of  chlorinated  Hme  upon  an  alcohoHc 
solution  of  iodide  of  potassium,  heated  at  104°  F.,  the  product 
being  iodoform  and  iodate  of  lime,  the  iodoform  being  sepa- 
rated by  boiling  alcohol.  It  is  in  the  form  of  small,  pearly 
crystals,  of  a  yellow  color,  with  an  unpleasant  odor,  like  that 
of  saffron,  and  a  sweetish  taste,  and  soft  to  the  touch.  It  is 
volatile,  and  soluble  in  alcohol,  chloroform,  ether  and  the  fixed 
and  volatile  oils,  but  insoluble  in  water. 

Medical  Properties  and  Action. — Iodoform  has  no  irritant 
action,  and,  in  small  doses  is  tonic,  stimulant,  anodyne,  alter- 
ative and  disinfectant,  having  great  influence  on  the  nervous 
system  ;  it  is  also  anti.septic.  In  large  doses,  it  causes  a  form 
of  intoxication,  followed  by  convulsions  and  fatal  effects.  In 
the  form  of  vapor,  it  possesses  anaesthetic  properties,  but  not 
equal  to  those  of  the  general  anaesthetics  in  common  use.  It 
has  also  been  used  as  a  local  anaesthetic,  aud  also  as  an  anti- 
.septic. Its  odor  can  be  detected  in  the  blood,  the  brain  and 
the  muscles. 


364  DENTAL   MEDICINE. 


Therapeutic  Uses. — Iodoform  produces  the  constitutional 
effects  of  iodine,  but  is  chiefly  used  externally  for  painful 
cancerous  and  phagedenic  ulcerations,  irritable  ulcers,  ill-con- 
ditioned wounds,  obstinate  skin  diseases,  scrofulous  glandular 
enlargements,  to  allay  the  pain  of  gout  and  neuralgia,  and  for 
phthisis,  mixed  with  starch  and  spread  on  paper,  so  that  the 
vapor  may  be  inhaled.  Dusted  over  a  diseased  surface,  it 
allays  pain  and  changes  the  morbid  action.  A  saturated 
solution  of  iodoform  in  chloroform  is  recommended  for  neu- 
ralgia ;  also  a  saturated  solution  in  any  of  the  essential  oils 
is  used  for  the  same  affection.  In  the  form  of  an  ointment,  it 
is  used  as  an  application  to  irritable  ulcers.  For  ulcerated 
surfaces,  it  may  be  sprinkled  over  the  part,  and  lint,  coated 
with  glycerine,  applied  as  a  dressing. 

Dose. — Of  iodoform,  gr.  j  to  gr.  iij,  three  times  a  day,  in  the 
form  of  a  pill. 

Dental  Uses. — Iodoform  is  highly  recommended  in  dental 
practice,  as  an  antiseptic,  either  alone,  or  what  is  better,  com- 
bined with  eucalyptus  oil.  It  possesses  no  escharotic  property 
sufficient  to  cause  irritation  or  the  destruction  of  parts.  In 
the  treatment  of  alveolar  abscess,  iodoform,  in  combination 
with  oil  of  eucalyptus,  has  given  great  satisfaction  ;  also  in  cases 
of  putrescent  pulps,  applied  as  an  injection.  It  is  recommended 
to  be  used  as  follows:  First,  an  injection  of  eucalyptus  oil, 
followed  by  the  introduction  of  the  mixture  of  iodoform  and 
eucalyptus  into  the  root  canal,  on  cotton,  or  on  a  strand  of 
floss  silk,  which  is  charged  by  first  dipping  it  into  the  oil,  and 
then  in  the  iodoform ;  or  the  two  may  be  combined  in  a  solu- 
tion (see  Eucalyptus),  and  in  this  form  introduced  into  the  sac 
or  root  canal.  Dr.  C.  N.  Pierce  recommends  iodoform  ground 
up  with  equal  parts  of  oil  of  cloves  and  oil  of  eucalyptus, 
which  forms  a  substance  of  a  soft  cheesy  consistence,  a  portion 
of  which  can  be  introduced  to  the  inflamed  part,  on  the  point 
of  a  small  broach.  Iodoform  is  also  a  very  serviceable  appli- 
cation in  alveolar  pyorrhoea.  A  saturated  solution  in  euca- 
lyptus oil  is  also  serviceable  as  an  external  application  in  neu- 
ralgia.    Iodoform  is  also  employed  as  an  anodyne,  for  the 


IODOFORM.  365 


relief  of  the  pain  following  the  extraction  of  teeth  affected 
with  periodontitis  and  alveolar  abscess ;  also  as  an  injection  in 
diseases  of  the  antrum,  and  as  a  packing  for  the  pus  pockets 
in  alveolar  pyorrhoea,  for  which  purpose  it  is  often  combined 
with  oil  of  eucalyptus,  or  oil  of  cinnamon.  Also  for  filling 
the  canals  of  pulpless  teeth,  for  which  purpose  a  paste  of 
iodoform  and  carbolic  acid  is  used,  and  allowed  to  remain  for 
a  few  days,  and,  if  no  soreness  follows,  a  permanent  root-filling 
can  then  be  introduced.  When  iodoform  is  used  alone,  a 
pellet  of  cotton  or  a  strand  of  floss  silk  may  be  dipped  into 
glycerine,  and  the  iodoform  be  thus  taken  up.  To  disguise 
the  unpleasant  odor  of  iodoform,  it  may  be  incorporated  with 
a  little  oil  of  rose,  as  one  drop  of  the  oil  will  remove  the  odor 
of  half  a  drachm  of  iodoform  ;  the  odor  is  also  disguised  by 
balsam  of  Peru,  oil  of  cinnamon,  oil  of  lavender,  or  oil  of  sassa- 
fras. Three  grains  of  cumurin  (a  derivative  of  the  Tonka 
bean)  will  disguise  the  odor  of  one  drachm  of  iodoform ;  or 
the  addition  of  attar  of  rose,  one  minim  to  the  drachm ;  or  of 
essence  of  rose  geranium,  three  or  four  minims  to  the  drachm. 
Creolin  is  also  a  very  good  deodorizer  of  iodoform  ;  also  aqua 
heliotrope,  for  the  hands  also,  one  or  two  drops  of  creasote  or 
carbolic  acid  to  the  ounce  of  iodoform,  is  also  recommended. 
According  to  some,  it  is  not  a  matter  of  indifference  whether 
iodoform  be  applied  as  a  dressing  for  wounds  and  ulcers,  in 
the  form  of  crystals,  as  amorphous  powder  dissolved  in  ether, 
or  as  an  ointment.  Iodoform  acts  not  only  as  a  chemical 
combination,  allowing  the  escape  of  iodine  in  a  free  state,  but 
it  has  certain  mechanical  properties.  When  the  surface  of  an 
ulcer  or  wound  is  covered  with  a  layer  of  iodoform  in  cry.stals, 
a  certain  degree  of  absorption  of  the  fluids  secreted  takes 
place.  These  products  of  secretion  penetrating  the  interstices 
between  the  minute  crystals  of  iodoform  soon  lose  the  liquid 
form,  and  produce  with  them  an  impermeable  crust.  Under 
this  crust  cicatrization  soon  occurs,  without  any  retraction  of 
the  tissues ;  hence  they  suppose  that  the  best  form  in  which 
to  employ  iodoform  for  ulcers  and  wounds  is  that  of  the  crys- 
tals.    As  toxic  effects  have  followed  the  internal  administra- 


366  DENTAL   MEDICINE. 


tion  of  iodoform,  it  should  be  prescribed  with  care,  and  also 
the  application  of  it  to  extensive  surfaces  should  be  avoided. 
The  toxic  symptoms  have  been  manifested  as  follows,  the 
maximum  dose  which  caused  them  in  a  certain  case  being 
12^  grains : 

"  Giddiness,  vomiting  and  deep  sleep,  from  which  the  patient 
could  be  roused  with  difficulty.  The  somnolence  was  inter- 
rupted by  periods  of  excitement,  each  lasting  several  hours, 
and  was  followed  by  delirium,  intense  headache,  sense  of  im- 
pending death,  spasmodic  contractions  of  the  facial  muscles, 
and  in  the  case  of  the  younger  patient,  diplopia.  The  functions 
of  the  other  sensory  organs  were  not  disturbed,  and  the  pupils, 
presented  a  normal  reaction.  Deep  inspirations  alternated 
with  apnoea  of  about  a  minute's  duration.  After  five  or  six 
days,  the  toxic  symptoms  gradually  lessened  and  passed  away." 

Iodoform  has  been  used  for  odontalgia,  on  account  of  its 
gently  caustic  and  anodyne  action  on  exposed  pulps  of  teeth. 
Combined  with  arsenious  acid  and  creasote  in  a  devitalizing 
mixture,  iodoform  is  supposed  to  lessen  the  pain  caused  by  the 
arsenical  paste. 

M.  Rummo,  of  the  Academy  of  Science,  regards  iodoform 
as  exerting  an  anaesthetic  action  when  applied  to  wounds,  but 
without  the  power  to  destroy  germs  in  putrescent  matter,  al- 
though it  prevents  their  development ;  but  dissolved  in  oil  of 
turpentine,  it  will  destroy  bacteria  in  their  fullest  proliferation. 
M.  Sauvat  says  that  iodoform,  when  applied  to  wounds,  reduces 
effusion  and  favors  cicatrization,  and  exerts  an  anaesthetic 
action ;  but  if  carelessly  used  it  may  cause  erythema  or  even 
erysipelas.  Iodoform  in  powder  is  now  a  popular  dressing  for 
wounds. 


IODOFORM. 


367 


DENTAL 

New  Methods  for  Deodorizing  Iodoform, 

I. — Carbolic  acid i  part. 

Iodoform 2  parts. 

Powder  and  mix  well. 

No  change  appears  to  take  place  in 
the  iodoform,  but  the  odor  is  marked  by 
that  of  carbolic  acid. 

2. — Iodoform loo  parts 

Oil  of  peppermint  ....      5  parts 

Oil  of  neroli I  part 

Oil  of  lemon 2  parts 

Tinct.  benzoin 2  parts 

Acetic  acid i  part. 

Powder  the  iodoform,  and  mix  thor- 
oughly with  the  other  ingredients. 
Transfer  to  a  well  stoppered  flask,  and 
keep  at  a  temperature  of  from  120° 
F.  to  140°  F.,  over  a  water  bath,  for 
two  days.  The  mixture  has  a  pleas- 
ant odor  of  Eau  de  Cologne. 

3. — Camphor 5  parts 

Charcoal 10  parts 

Iodoform 15  parts. 

Powder  and  mix  intimately. 

For  Pulpless  Teeth. 

R.     lodoformi gr.x 

Acidi  tannici gr.iij 

Glycerini gtt.xv.  M. 

SiGNA. — Apply  on  floss  silk,  or  by 
syringe. 

Preparation. — Rub  iodoform  to  fine 
powder,  in  a  mortar,  and  add  the 
tannin,  and  after  mixing  thoroughly, 
add  the  glycerin.  One  drop  of  oil  of 
cinnamon  will  disguise  the  odor, . 

For  Devitalizing  Pulps  of  Teeth. 

B  .     lodoformi gr.v 

Acidi  arsenics  ....  gr.x 

Creasoti q.s.       M. 

To  make  a  paste. 
SiGNA. — Apply  on  cotton,  or  on  point 
of  a  broach. 


FORMULiE. 

For  Putrid  Pulps. 
A.  P.  Johnston. 

R  .     lodoformi ^-^^ 

Camphorse 5  ^ 

Alcoholis ^j. 

Misce  by  dissolving  the  camphor  in 
the  alcohol,  and  then  add  the  iodoform. 
SiGNA. — Use  as  an  injection. 

As  a  capping  for  an  exposed  pulp,  it 
is  suggested  to  dissolve  the  filings  of 
celluloid  in  the  above  mixture  and  form 
a  thick  paste. 

For  Odontalgia. 
ScHAFF. 
R.     Pulv.  lodoformi  ....  gr.lx 

Kaolin gr.lx 

Acidi  carbolic!  ....  gr.viij 

Glycerini q.s. 

Olei  menthre  piperit  .    .  gtt.x. 
Triturate  the   iodofonn,  kaolin,  and 
oil  of  peppermint,  with  enough  glycerine 
to  form  a  thick  paste. 
SiGNA. — Apply  to  exposed   surface  of 
pulp. 

For  Pulpless    Teeth   with  a   Fistulous 
Opening. 

Faught. 

R.     lodoformi ^j 

Acidi  tannici ^\^ 

Glycerini f^ij 

Morphinje  acetat  ....  jj.  M. 

Signa. — Apply  on  floss  silk. 

For  Neuralgia  and  Tumors  of  the  Gums. 

R.     lodoformi grxv. 

Bals.  Peru gr.xxx 

Glycerini  vel  vaselin  .  .  q.s.       M. 
To  make  a  solution  or  ointment. 
Signa. — To  be  applied  as  a  solution; 
or,  if  the  vaseline  is  used,  as  an  oint- 
ment. 


368  DENTAL   MEDICINE. 


For  Pulpitis,  as  a  Capping.  For  Pulpless   Teeth — Canal- Dressing. 

Easchkis.  Pierce. 

B .     lodofonni  pulv.,  R .     lodoformi, 

Kaolin  pulv  .    .  aa  .    .  gr.lx  Olei  caryophilli, 

Acidi  carbolici  (cryst.)  gr.viij.  Olei  Eucalypti  .  aa  .    .    ^vj.     M. 

Mix,  and  add  sufficient  glycerine  to  SiGNA. — Apply    by    injection     or     on 

form  a  paste,  then  add  : —  floss-silk. 

01.  menth  pip  ....  gtt.x, 

SiGNA. — Apply,    on    point    of    broach  For  an  Ointment  of  Iodoform   and  Eu- 

over  inflamed  portion.  calyptus. 

R.     Pulv.  iodoformi    .    .    .    ^ss 

For  Tumors,  Enlarged  Glands,  etc.  Olei  eucalypti  .    .    .    .  f^ss 

R .     lodoformi part,  j  Vaselin ^  iv.     M. 

Collodii part,  x,    M.  Signa. — To  be  used  as  an  ointment. 

SiGNA. — To  be  applied  as  a  lotion. 

lODOL— TETRAIODOPYRROL. 

Fonmda. — QH  NI4. 

Derivation. — lodol  is  obtained  by  the  action  of  iodine  on 
certain  constituents  of  animal  oil.  It  is  in  the  form  of  a 
grayish-white  powder,  which  becomes  dark  on  exposure  to 
light. 

It  is  odorless  and  has  little  taste,  and  contains  90  per  cent, 
of  iodine.  It  is  quite  soluble  in  alcohol,  ether,  chloroform, 
carbolic  acid,  olive  oil  and  alkaline  solutions,  but  insoluble  in 
water;  combination  with  an  equal  part  of  glycerine  does  not 
affect  its  properties. 

Medical  Properties  and  Therapeutic  Uses. — lodol  is  anti- 
septic, deodorant  and  anaesthetic.  It  is  an  efficient  germicide 
without  poisonous  effects,  and  is  free  from  the  disagreeable 
'  odor  and  taste  of  iodoform.  Its  physiological  action  and 
therapeutic  uses  are  the  same  as  those  of  iodoform.  When 
applied  to  an  abraded  or  wounded  surface,  it  can  soon  be  de- 
tected in  the  urine  and  saliva ;  also  the  same  effects  are  appa- 
rent when  it  is  administered  by  the  stomach. 

Its  action  is  slower  than  that  of  iodide  of  potassium,  but 
more  prolonged,  and  its  elimination  is  slower.  It  has  a  slight 
caustic  action,  but  a  larger  quantity  can  be  used  when  'it  is 
substituted  for  iodoform ;  no  quantity  applied  to  a  wound  will 
cause  toxic  symptoms. 


lODOL.  369 

It  is  used  on  wounds,  ulcers,  etc.,  in  the  form-  of  an  impal- 
pable powder,  which  is  dusted  on  the  part.  It  is  also  em- 
ployed in  the  form  of  an  ethereal  solution,  and  also  in  solu- 
tion with  alcohol  and  glycerine ;  also  in  the  forms  of  iodol 
cotton  and  gauze,  pastils,  bougies  and  ointments.  It  improves 
morbid  conditions,  and  can  be  advantageously  substituted 
for  iodoform.  It  has  been  administered  with  good  results 
in  the  treatment  of  laryngeal  tuberculosis  by  insufflation  of 
the  powder ;  and  the  loss  of  appetite,  so  common  as  a  re- 
sult of  the  use  of  iodoform,  does  not  occur,  ulcers  become 
rapidly  clean  and  the  tendency  to  form  scars  is  scarcely  ob- 
served. 

Iodol  is  also  employed  internally,  in  the  form  of  pills  of  3 
grains  in  the  treatment  of  substernal  struma.  In  the  treat- 
ment of  syphilitic  ulcers,  round  ulcers,  suppurating  buboes, 
and  after  opening  the  pustules  of  acne,  it  has  also  given  favor- 
able results,  as  it  lessens  the  secretion,  possesses  great  disin- 
fectant power  and  is  non-irritating. 

Dose. — For  internal  administrations,  gr.  ^^^  to  gr.  v.  in  wafer 
pill,  or  pellet,  or  in  powder. 

Dental  Uses. — Same  as  those  of  Iodoform  (which  see). 

For  a   Topical  Application.  For  Root-Canals  of  Abscessed  Teeth. 

Mazzoni.  Van  Wort. 

R.     Iodol I  part.  R.     Iodol gr.x. 

Alcoholis 16  parts.  Zinci  oxidi      ....  gr.xx. 

Glycerini 34  parts.  Vaseline   carbol.    q.s.    to   form   a 

SiGNA. — Apply    with     a     camel's-hair  thick  paste.                              M. 

brush  or  in  the  form  of  spray.  SJGNA. — Place  in  canal  and  seal  with 

an  oxyphosphate  filling. 
Dental  Varnish. 

R.     Saturated  solution  of  iodol  in  al-  For  a   Topical  Application. 

cohol I  part.  Evaporating  quickly. 

Hubbard's        negative       varnish  R.     Iodol I  part. 

6  parts.                                      M.  /Ether  sulph  ....  8  parts.    M. 
A  good,  quick  drying  varnish. 

lODUM— IODINE. 
Formula. — I. 

Derivation. — Iodine    is  a  non-metallic,  metalloid   element, 
obtained  principally  from  kelp  (made  by  burning  seaweed,  and 
24 


370  DENTAL   MEDICINE. 


in  the  form  of  impure  soda),  which  is  subjected  to  distillation 
in  iron  retorts,  after  which  it  is  mixed  with  sulphuric  acid  and 
black  oxide  of  manganese.  It  is  evolved  in  the  form  of  vapor, 
which  is  condensed.  The  vapor  is  readily  recognized  by  its 
beautiful  violet  color.  Iodine  is  usually  in  the  form  of  bluish- 
black  crystalline  scales,  with  a  metallic  lustre,  a  strong,  peculiar 
odor  and  a  hot,  acrid  taste.  It  is  slightly  soluble  in  water 
and  soluble  in  alcohol,  ether,  solution  of  chloride  of  sodium 
and  a  solution  of  iodide  of  potassium. 

Medical  Properties  and  Action. — Iodine  in  small  doses  is 
alterative,  stimulant  and  tonic,  and  acts  locally  as  an  irritant, 
causing  redness,  itching  and  desquamation ;  exhaled  in  the 
form  of  vapor,  it  excites  cough  and  warmth  in  the  air  pas- 
sages. Taken  internally  it  excites  a  sensation  of  heat  or 
burning  in  the  stomach,  and  in  large  doses  is  an  irritant  poison, 
inflaming  the  mucous  membrane  of  the  stomach  and  causing 
superficial  eschars.  The  internal  use  of  the  iodides  gives  rise 
to  an  eruption  of  acne,  especially  on  the  face,  thighs  and 
shoulders ;  they  have  also  anaphrodisiac  powers  when  long 
continued.  The  influence  of  the  iodides  in  producing  iodism 
may  be  prevented  by  large  draughts  of  water  being  used 
during  their  administration. 

The  odor  of  iodine  can  be  detected  in  the  blood,  brain  and 
muscles. 

When  combined  with  potassium  its  local  irritant  effect  is 
diminished ;  hence,  the  preparation  known  as  Iodide  of  Po- 
tassium, Potassii  lodidum  (obtained  by  treating  an  aqueous 
solution  of  potassa  with  iodine),  is  employed  whenever  the 
constitutional  effects  of  iodine  are  desired,  as  the  iodide  of 
potassium  possesses  many  advantages  over  iodine  for  internal 
use,  such  as  being  less  irritant,  and  for  this  reason  may  be  ad- 
ministered in  larger  doses  and  for  a  greater  length  of  time ;  it 
is  also  more  soluble  than  iodine  alone,  and  when  taken  into 
the  stomach  is  absorbed  much  more  rapidly.  The  formula  is 
Ki,  and  it  is  in  the  form  of  white  crystals,  of  an  acrid,  saline 
taste.  Some  persons  are  peculiarly  susceptible  to  the  influ- 
ence of  iodine,  even  small  doses  causing  unpleasant  effects, 


IODINE.  371 

such  as  headache,  vertigo,  derangement  of  the  digestive  or- 
gans, etc. 

Iodide  of  potassium,  like  iodine,  produces  a  very  decided 
effect  on  the  secretions,  increasing  them,  and  occasionally  to 
the  degree  of  ptyalism.  The  antidote  for  poisoning  by  iodine 
is  starch. 

Therapeutic  Uses. — Iodine  and  its  preparations  are  valuable 
resolvents  in  the  treatment  of  glandular  enlargements,  indura- 
tions, tumors,  thickening  of  membranes,  etc.,  etc.;  also  in 
scrofula,  scrofulous  ophthalmia,  tubercular  meningitis,  ad- 
vanced stage  of  pleurisy,  chronic  affections  of  the  liver,  etc., 
etc. 

Iodide  of  potassium  is  much  employed  in  mercurial  poison- 
ing and  in  syphilis,  especially  in  the  secondary  and  tertiary 
forms,  and  after  the  employment  of  mercury  has  proved  use- 
ful ;  also  in  affections  of  the  nervous  system  of  a  syphilitic 
origin,  together  with  the  other  affections  already  referred  to 
as  indicating  iodine.  Externally  iodine  is  used  in  the  form  of 
tincture  in  the  treatment  of  enlarged  scrofulous  glands,  cuta- 
neous affections,  erysipelas,  rheumatism,  gout,  phlegmons, 
syphilitic  gummatae  and  nodes,  phagedaenic  ulcerations,  car- 
buncles, diseases  of  the  joints,  wounds  and  parts  poisoned; 
and  as  a  counter-irritant  in  pneumonia,  phthisis  and  pleurisy ; 
and  as  injections  in  hydrocele  and  bronchocele.  The  vapor 
is  inhaled  with  benefit  in  chronic  bronchitis  and  phthisis. 
Iodine  also  ranks  highly  as  a  disinfectant. 

Dose. — Of  iodine  alone,  gr.  ^  to  gr.  j  two  or  three  times  a 
day,  in  the  form  of  a  pill,  directly  after  eating,  on  account  of 
its  irritant  effect;  the  best  form  of  administration,  however,  is 
iodide  of  potassium.  Dose  of  the  iodide  of  potassium,  gr.  iij 
to  gr.  X. 

Tincture  of  Iodine — Tinctura  lodi  (iodine,  5j ;  alcohol,  Oj). 
Dose,  inj  to  1TLv. 

Compound  Tincture  of  Iodine — Tinctura  lodi  Coinposita 
(iodine,  .^ss  ;  iodide  of  potassium,  .5j ;  alcohol,  Oj).    Dose,  Itlij 

to  ntx. 

Colorless  Iodine — Iodine  is  bleached  by  carbolic  acid,  and 


372  DENTAL   MEDICINE. 

the  colorless  carbolate  combines  all  the  advantages  of  both 
base  and  acid.  One  of  the  easiest  methods  to  decolorize 
iodine  is  to  add  forty  minims  of  a  saturated  solution  of  hypo- 
sulphite of  soda  to  each  fluid  ounce  of  the  tincture  of  iodine. 
Forty  minims  of  the  saturated  solution  contain  about  thirty- 
two  grains  of  sodic  hyposulphite.  Another  method  of  decol- 
orizing iodine  is  to  put  into  an  open  vessel  a  drachm  of  the 
tincture  of  iodine  and  six  ounces  of  hot  water ;  add  twelve 
grains  of  phenol  and  stir  with  a  glass  rod,  when  the  solution 
will  be  at  once  bleached. 

De7ital  Uses. — In  dental  practice  iodine  and  its  preparations 
are  valuable  agents,  the  official  and  compound  tinctures  being 
employed  in  the  treatment  of  periodontitis,  alveolar  abscess, 
mercurial  stomatitis  and  other  forms  of  stomatitis,  inflamma- 
tion and  ulceration  of  the  gums,  fungous  growths  of  gum 
and  tooth  pulp,  necrosed  teeth  and  suppurating  pulps  of 
teeth,  diseases  of  the  antrum,  caries  of  maxillary  bones,  den- 
tigerous  cysts,  recession  of  gums  and  absorption  of  alveolar 
processes. 

For  the  different  forms  of  stomatitis,  and  especially  mercu- 
rial stomatitis,  the  tincture  of  iodine  is  used  in  the  form  of  a 
gargle ;,  for  an  injection  in  alveolar  abscess  it  is  diluted  or 
combined  with  carbolic  acid,  glycerine  and  other  agents ;  for 
fungous  growths  it  may  be  used  alone,  or  combined  with  rec- 
tified alcohol;  for  ulcerations  of  gum  and  mucous  membrane 
it  is  generally  combined  with  carbolic  acid ;  for  periodontitis  it 
is  combined  with  the  tincture  of  aconite  root,  and  is  regarded 
as  being  almost  a  specific  for  the  incipient  stages  of  this  affec- 
tion, as  it  relieves  the  inflammation  by  retarding  the  circulation 
and  stimulating  lymphatic  action.  Either  the  officinal  or  com- 
pound tincture  is  employed  with  an  equal  quantity  of  the 
tincture  of  aconite,  the  preparation  being  applied  to  the  gum 
over  root  of  affected  tooth,  which  should  be  previously  dried 
of  moisture,  by  means  of  a  camel's-hair  brush  or  cotton  on  the 
point  of  an  excavator.  The  mouth  should  be  kept  open  and 
the  part  protected  until  a  metallic  pellicle  is  formed.  Iodine 
is  also  a  valuable  disinfectant  and  germicide  in  the  treatment 


IODINE.  373 

of  alveolar  abscess  (in  the  form  of  the  compound  tincture), 
used  as  injections  throughout  the  pus  tract,  and  for  root  canals 
and  the  pus-pockets  of  alveolar  pyorrhoea. 

A  valuable  combination  of  iodine,  carbolic  acid,  glycerin 
and  water  is  known  as  "  Boulton's  Preparation,"  and  is  a  useful 
application  in  the  form  of  injections,  gargles  and  lotions.  For 
the  chronic  form  of  alveolar  abscess,  and  also  for  the  acute 
form,  after  more  powerful  agents  have  been  employed,  it  is  a 
useful  remedy,  possessing  antiseptic  and  stimulant  properties 
in  a  marked  degree ;  it  also  possesses  the  property  of  modify- 
ing mucous  membrane  and  diminishing  sensibility ;  hence  it  is 
useful  in  ulcerations,  etc.  Tincture  of  iodine  combined  with 
creasote  or  carbolic  acid  is  a  powerful  application  in  peri- 
odontitis, suppuration  of  necrosed  teeth,  ulceration  of  margins 
of  the  gums  and  for  fungous  growth,  as  it  stimulates  debilitated 
parts  and  destroys  such  as  are  too  weak  to  be  restored.  A 
colorless  tincture  of  iodine  is  composed  of  glycerin  and  aqua 
ammonia  in  combination  with  the  iodine,  but  the  presence  of 
the  ammonia  restricts  its  use.  Another  colorless  tincture,  in 
which  sulphate  of  soda  is  substituted  for  the  ammonia,  is  less 
irritating  in  its  effects. 

The  addition  of  water  and  honey  to  the  officinal  tincture 
of  iodine  will  render  it  suitable  for  a  gargle  for  inflamed  and 
ulcerated  parts.  The  iodide  of  potassium  is  employed  inter- 
nally in  mercurial  stomatitis,  dental  exostosis,  facial  neuralgia, 
convulsions  of  dentition,  periodontitis,  looseness  of  the  teeth, 
tumefaction  and  sponginess  of  the  gums,  syphilitic  and  scrof- 
ulous ulcerations  of  the  mouth,  caries  and  necrosis  of  the 
maxillary  bones. 

Tincture  of  iodine  mixed  with  glycerin  is  claimed  by  Dr. 
Hammond  to  be  more  effective  as  a  local  application  than  the 
plain  tincture.  This  is  due  to  the  retardation  of  the  dissipa- 
tion of  the  iodine,  or  more  probably  to  the  skin  remaining 
soft,  and  therefore  in  a  better  condition  for  absorbing  the 
drug. 


374 


DENTAL  MEDICINE. 


DENTAL  FORMULAE. 


For  Chronic  Alveolar  Abscess,  Ulcera- 
tions, Inflammations,  etc.,  etc. 

BOULTON. 

R  •    Tinct.  iodi.  comp    .    .    .  TH.^l''' 
Acidi  carbolici  (cryst)    ,  "tTLvj 

Glycerinse §j 

Aquse  destillatae  .    .    .    .  ^  v      M. 
It  becomes  colorless  in  from  8  to  lo 
hours. 
SiGNA. — To  be  used  as   an   injection, 
gargle  or  lotion. 


For  Ulceration  of  Gums. 

R .    Tinct.  iodi Hlxlv 

Acidi  carbolici    .    .    .  TT^vj 

Glycerini ^j 

Aquse  destillatse      .    .  ^  v. 

SiGNA. — Apply  as  a  lotion. 


M. 


R. 


For  Periodontitis. 
Tinct.  iodi ^j 


Creasoti         vel., 

Acidi  carbolici    .    .    .-^ss,        M. 
SiGNA. — To  be  applied  to  gum  about 
neck  of  tooth,  as  a  counter-irritant. 

For   Ulcerated  Gums  and  Mucous 
Mefnbrane. 

R .    Tinct.  iodi  ....  partem  j 

Mellis partes  ij 

Aquse partes  vij.    M. 

SiGNA. — To  be  used  as  a  gai^le. 

For  Periodontitis. 

R.    Tinct.  iodi ^x 

Potassii  iodidi      .    .    .    .  §  ss 

Camphorae ^\] 

Spiriti  rectificati      .    .    .  f§x.    M. 
SiGNA. — Apply    with    a    camel's   hair 
brush  to  gvmi  over  root  of  affected 
tooth. 


For  Fungous  Growths  and  Suppurating 
Surfaces. 

R .    Tinct.  iodi ^!^  ij 

Spiriti  rectificati      .    .    .  ^j.      M- 
SiGNA. — To  be  applied  with  a  camel's- 
hair  brush. 

For  Mercurial  Stomatitis . 

R .    Tinct.  iodi  .    .    .    .  5  iij  vel  vj 
Potassii  iodidi     .    .  gr.xv  vel  xxx 
Aquse Oss.  M. 

SiGNA. — To  be  used  as  a  gargle. 

For  Periodontitis. 
R.    Tinct.  iodi., 

Tinct.  aconiti  .    .  aa  .    .  ^ss.    M. 
SiGNA. — To  be  applied  by  means  of  a 
camel' s-hair  brush   until    a  metallic 
pellicle  is  formed,  three  times  daily. 

For  Excessive  Sweating  of  the  Hands. 

R .    Tinct.  iodi ^^  j 

Lin.  camphorae  comp., 
Glycerinse    .    .  aa  .    .    .  ^iss 
Lin.  belladonna  comp    .  ^j 
Eau  de  cologne  .    .    .    .  ^j.      M. 
SiGNA. — Apply  as  an  embrocation  twice 
a  day,  having  previously  well  bathed 
the  hands  in  warm  water,  in  which 
is  dissolved  two  drachms  or  half  an 
ounce  of  chloride  of  ammonia  and 
four  drachms   of  carbonate   of  soda 
crystals,  enough  water  being  used  to 
well  cover  the  hands. 

For  Putrescent  Pulps  and  Chronic 
Alveolar  Abscess. 


R.    Iodi     .    . 
Alcoholis 


3iJ 


M. 


For  Same  and  Pyorrhxa  Alveolaris. 

R.    Iodi, 

Acidi  carbolici  (crystals)aa;:5J 
Alcoholis f^ij.M, 


TRICHLORIDE  OF  IODINE.  375 

IODINE  TRI-CHLORIDE— TRICHLORIDE  OF  IODINE. 

Formtda.—  ICI3. 

Derivation. — Iodine  tri-chloride  is  obtained  by  the  action  of 
chlorine  on  iodine.  It  is  an  orange-red  powder,  whose  odor 
strongly  irritates  the  mucous  membrane.  Usual  dilution 
1 :  1 200. 

Medical  Properties  and  Therapeutic  Uses. — Tri-chloride  of 
iodine  is  antiseptic  and  disinfectant,  being  highly  efficient  as 
such,  through  the  liberation  of  chlorine  whose  nascent  ener- 
getic effect  is  still  further  enhanced  by  the  presence  of  iodine. 
The  antiseptic  power  of  tri-chloride  of  iodine  was  officially 
tested  by  the  Imperial  Sanitary  Bureau  of  Germany,  and  the 
following  result  was  ascertained  :  "An  aqueous  solution  of  i 
in  1000  destroys  resistant  bacillus- spores  within  a  compara- 
tively short  time ;  but  only  the  aqueous  solution  does  this. 
Alcoholic  or  oily  solutions  proved  ineffective.  Iodine  tri- 
chloride far  surpasses  carbolic  acid,  and  is  next  to  corrosive 
sublimate  (bi-chloride  of  mercury),  in  antiseptic  power."  It 
may  be  obtained  in  quantities  of  ten  grammes  in  hermetically 
sealed  tubes,  and  is  best  kept  in  five  per  cent,  aqueous  solu- 
tions which  appear  to  remain  unchanged  for  some  months. 
Langebuch  claims  that  a  o.i  to  0.15  per  cent,  solution  is  equal 
in  antiseptic  action  to  a  0.5  to  i.o  per  cent,  solution  of  bi- 
chloride of  mercury  ;  in  other  words  that  it  is  about  five  times 
as  efficient  as  the  bi-chloride.  It  is  also  claimed  to  be  rela- 
tively the  least  poisonous  of  all  antiseptics.  Behring  found 
that  in  aqueous  solutions,  having  equal  action  upon  the  spores  of 
anthrax  bacilli,  sublimate  is  five  to  six  times,  and  carbolic 
acid  and  creasote  seven  to  eight  times,  as  poisonous  as  the 
tri-chloride. 

Dental  Uses. — Dr.  W.  D.  Miller  says :  "  We  have  con- 
sequently reasons  to  hope  that  the  tri-chloride  of  iodine  may 
prove  a  valuable  remedy  in  the  treatment  of  diseased  con- 
ditions of  the  teeth  and  mouth."  Its  efficiency  as  a  disinfect- 
ant for  carious  dentine  has  been  clearly  shown  in  the  experi- 
ments of  Dr.  Miller,  and  his  impression  was  that  the  five 
per  cent,  solution  of  the  tri-chloride  of  iodine   is   one  of  the 


376  DENTAL   MEDICINE. 


most  active  agents   for  sterilizing  carious  cavities,  and  disin- 
fecting carious  dentine  preparatory  to  filling  teeth. 

lODOPHENACETIN. 

Derivation. — A  new  derivation  of  phenacetin  described  by 
Dr.  Scholvein,  obtained  when  a  cold-saturated  solution  of 
phenacetin,  acidulated  with  hydrochloric  acid,  is  treated  with 
iodine.  It  first  forms  as  a  gray  precipitate,  which  afterwards 
appears  as  a  mass  of  crystalline  needles  or  an  amorphous 
mass.  It  forms,  when  dry,  a  chocolate-brown  powder.  When 
recrystallized  from  glacial  acetic  acid,  it  may  be  obtained  in 
steel-blue  crystals.  By  dissolving  the  phenacetin  in  glacial 
acetic  acid  and  afterwards  diluting  with  water,  less  quantities 
of  liquid  are  required  in  its  preparation  than  would  be  the 
case  if  a  mere  aqueous  solution  of  phenacetin  was  employed. 
The  resulting  product,  called  "  zWij^/Zz^rnVz,"  melts  at  I30°C., 
decomposing  at  the  same  time.  It  contains  one  portion  of  its 
iodine  in  a  more  intimate  combination  than  the  other.  It  is 
soluble  in  20  parts  of  cold  glacial  acetic  acid,  more  easily  in 
the  same  liquid  when  hot,  and  is  soluble  in  alcohol,  but  not 
readily  soluble  in  benzole  and  chloroform.  If  heated  with 
water,  it  is  decomposed.  It  has  a  strong  odor  of  iodine,  and 
a  burning  taste.  Ordinarily  it  contains  50.5  per  cent,  of 
iodine. 

Medical  Properties  and  Therapeutic  Uses. — lodophenacetin 
is  an  antiseptic,  and  possesses  marked  powers  as  a  bactericide; 
but  when  given  subcutaneously  it  produces  marked  local  irri- 
tation, and  when  given  internally  it  forms  combinations  with 
the  alkalies  of  the  intestinal  canal,  and  consequently,  from  the 
readiness  with  which  iodine  is  given  up,  iodine-poisoning  may 
readily  follow  the  administration  of  even  small  doses. 

IRIDIS  RHIZOME— ORRIS  RHIZOME— ORRIS  ROOT. 

Source. — The  plant  from  which  Orris  Root  is  obtained  is  a 
native  of  Italy  and  the  south  of  Europe.  It  belongs  to  the 
natural  order  Iridaceae,  of  which  there  are  three  varieties  of 
the  species  of  Iris — Iris  Rhizoma,  Iris  Florentina  and  Iris  Ger- 


GUTTA   PERCHA.  377 


manica.  The  root,  which  is  the  officinal  portion  of  the  plant, 
is  of  various  forms  and  sizes,  often  branched,  usually  knotty 
and  flattened,  white,  heavy,  and  of  the  thickness  of  the  finger. 
It  has  a  pleasant  odor,  like  that  of  violet,  and  a  bitter,  acrid 
taste. 

Medical  Properties  and  Action. — Orris  root  is  cathartic  and 
diuretic,  and  in  large  doses  emetic.  It  has  been  employed 
with  some  benefit  in  dropsies,  but  is  not  often  administered  as 
a  general  remedy  at  the  present  time.  It  is  valued  for  its 
pleasant,  violet  odor. 

Dental  Uses. — In  dental  practice  it  is  employed  as  a  very 
common  ingredient  of  dentifrices,  and  also  to  correct  an 
offensive  breath. 

DENTAL   FORMULA. 

Dentifrice, 
Dr.  Sewell. 

R .    Pulv.  radicis  iridis ^  ss 

Pulv.  saponis  cas 3  ij 

Pulv.  sodii  boratis 3  ij 

Cretse  preparatoe ,^ij.     M. 

Flavor  with  a  few  drops  of  oil  of  cloves  and  lavender. 
Or,  add  a  few  drops  of  carbolic  acid  to  each  ounce  of 
the  powder,  and  flavor  the  whole  with  eucalyptus  oil. 

'       ISONANDRA   GUTTA— GUTTA   PERCHA. 

Source. — Gutta  Percha  is  the  inspissated  juice  of  the  tree 
Isonandra  Gutta,  extensive  forests  of  which  are  found  in  the 
East  Indies.  It  belongs  to  the  natural  order  Sapotacece.  It  is 
in  the  form  of  tough,  flexible  pieces,  which  have  been  freed 
from  impurities  by  cutting  it  into  thin  slices,  and  then  washing 
and  tearing  it  into  shreds  by  heavy  machinery  while  it  is  soft- 
ened in  boiling  water.  It  may  be  more  thoroughly  purified  by 
dis.solving  it  in  either  chloroform,  benzol  or  hot  turpentine, 
thus  causing  the  impurities  to  separate,  when  it  is  evaporated 
to  dryness.  Crude  gutta  percha  is  of  a  chocolate  or  reddish- 
brown  color;  commercial  gutta  percha  is  of  a  grayish-white 
color,  and  the  variety  which  has  been  purified  by  dissolving  it 
in  chloroform,  etc.,  is  almost  white,  greasy  to  the  touch,  and  of 


378  DENTAL  MEDICINE. 


a  leathery  smell,  like  that  of  India  rubber.  It  is  insoluble  in 
water  at  any  temperature,  and  is  a  bad  conductor  of  heat  and 
electricity.  At  ordinary  temperatures  it  is  tough,  hard  and 
inelastic,  but  toward  120°  F.  it  softens,  and  at  150°  it  becomes 
soft  and  plastic,  and  may  be  moulded  into  any  form,  which  it 
will  retain  on  cooling,  having,  however,  a  perceptible  shrink- 
age. Gutta  percha  is  dissolved  cold  by  chloroform  and  sul- 
phide of  carbon ;  benzol  requires  the  aid  of  heat  and  oil  of 
turpentine  requires  to  be  quite  hot.  The  alkalies  have  no 
action  upon  it ;  but  concentrated  nitric  acid  attacks  it  rapidly, 
with  effervescence  and  the  escape  of  nitrous  fumes. 

Dental  Uses. — Combined  with  mineral  substances  it  forms  a 
plastic  material  for  temporary  fillings  of  teeth,  and,  colored 
with  vermilion,  is  used  for  taking  impressions  of  the  mouth 
and  for  the  base  plates  of  plastic  work.  It  is  often  employed 
as  a  filling  material,  on  account  of  its  non-conducting  property, 
protecting  a  partially  exposed  pulp  or  sensitive  dentine  sur- 
face from  irritation  when  metallic  fillings  would  not  be 
tolerated.  Gutta  percha  has  also  been  used  for  interdental 
splints. 

The  preparation  known  as  "  Hill's  Stopping"  is  composed 
of  gutta  percha,  quicklime  and  feldspar,  the  mineral  ingredi- 
ents being  incorporated  with  the  gutta  percha  while  the  latter 
is  in  a  plastic  condition  from  the  effects  of  heat. 

Solution  of  Gutta  Percha — Liquor  Gutta  Percha,  Chloro- 
percha,  is  composed  of  gutta  percha,  Siss  ;  chloroform,  5xvij; 
or  a  thick  solution  may  be  made  by  dissolving  as  much  gutta 
percha  in  chloroform  as  will  give  the  desired  consistence  (like 
that  of  thick  cream). 

Solution  of  gutta  percha  is  a  useful  application  for  the  relief 
of  odontalgia  arising  from  an  exposed  and  inflamed  pulp ;  also 
for  capping  an  exposed  pulp,  a  more  durable  material  being 
inserted  over  it.  The  chloroform  of  the  solution  quickly 
evaporates,  leaving  an  impermeable  covering  of  the  gutta 
percha,  which  is  non-irritable,  non-conducting  and  protective. 
It  is  also  a  useful  application  for  inflamed  or  abraded  surfaces, 
chaps,  skin  affections,  etc.     Gutta  percha  dissolved  in  chloro- 


KRAMERIA.  379 


form  is  a  popular  and  efficient  material  for  root  fillings,  as 
are  also  cones  of  gutta  percha  softened  by  heat  or  in  chloro- 
form. 

KAXDOL. 

Kandol  is  a  product  formed  by  the  distillation  of  naphtha, 
and  is  a  perfectly  clear,  colorless  fluid,  extremely  volatile, 
burns  easily,  and  has  a  slight  odor  of  benzine.  It  can  be  mixed 
with  a  small  quantity  of  water  or  alcohol,  and  its  preparation 
is  cheap  and  simple.  Dr.  Njuschkon  advocates  the  use  of 
kandol  in  the  place  of  ether  or  cocaine  as  a  local  anaesthetic 
in  the  form  of  spray.  In  one  minute  kandol  will  reduce  the 
temperature  to  10°  C,  and  keep  it  nearly  uniform  at  that 
temperature  for  some  time,  while  ether  reduces  the  temperature 
to  17°  C.  As  an  effect  of  the  spray  of  kandol,  the  skin  be- 
comes very  hard  and  is  completely  anaesthetized,  and  there  is 
no  bleeding,  or  else  the  blood  coagulates  as  soon  as  it  makes 
its  appearance,  so  that  all  operations  may  be  performed  with 
ease  and  rapidity. 

KRAMERIA. 

RHATANY. 

Source. — Krameria  is  obtained  from  the  root  of  the  shrub 
krameria  triandra,  of  the  natural  order  Polygale<z,  native  of 
Peru.  It  is  in  the  form  of  cylindrical  pieces,  of  the  thickness 
of  a  quill,  with  many  branches  of  a  light  red  color  within  and 
crossed  by  a  reddish-brown  bark.  The  root  is  without  odor, 
and  of  an  astringent  and  somewhat  bitter-sweetish  taste. 

Medical  Properties  and  Actioji. — Krameria  is  a  powerful 
astringent,  its  medicinal  property  being  due  to  tannic  acid,  of 
which  it  contains  about  forty  per  cent.  There  is  also  present 
an  odorous  principle,  wax  gum,  and  a  peculiar  acid  known  as 
krameric  acid.  When  chewed  it  imparts  a  red  tinge  to  the 
saliva.  It  imparts  its  properties  very  readily  to  alcohol,  but 
less  so  to  both  cold  and  boiling  water. 

Therapeutic  Uses. — Krameria  is  employed  internally  for  its 
astringent  and  a  slightly  tonic  effect  in  the  treatment  of  diar- 
rhcea,  dysentery,  passive  hemorrhages,   menorrhagia,  leucor- 


380  DENTAL   MEDICINE. 


rhoea,  etc.  Externally,  in  the  form  of  powder,  tincture  and 
infusion,  in  the  treatment  of  ozaena,  ophthalmia,  etc.,  and  as 
an  enema  in  hemorrhoids,  fissures  of  the  anus,  sore  nipples, 
leucorrhoea,  etc.,  etc. 

Dose. — Of  powdered  krameria,  gr.  xx  to  gr.  xxx  ;  of  the 
extract — extractum  kramericB,  the  dose  is  gr.  v  to  gr.  x ;  of 
the  infusion — infusum  kramericB — (krameriae  Sj ;  water,  Oj), 
the  dose  is  Sss  to  Sj  ;  of  the  tincture — tinctura  kramerioe — 
(krameriae,  3vj  ;  diluted  alcohol,  Oij),  the  dose  is  5j  to  5ij. 
Of  the  fluid  extract — extractum  kramericB  fluidum.,  the  dose  is 
nX  V  to  5ss ;  of  the  syrup — syriipiis  kramericB,  the  dose  is  5j 
to  5iv. 

Dental  Uses. — Krameria  is  a  valuable  astringent  in  dental 
practice,  being  employed  in  the  form  of  the  tincture,  in  ulcer- 
ated and  spongy  gums ;  in  the  form  of  the  infusion,  as  a 
gargle  in  inflammation  of  the  gums  and  mucous  membrane; 
in  the  form  of  the  powder  and  also  tincture,  in  spongy  and 
bleeding  gums,  as  an  astringent ;  and  also  in  the  form  of  the 
powder  as  an  ingredient  of  dentifrices,  for  its  astringent 
property. 

DENTAL   FORMULA. 
Astringe7tt  and  Stimulant  Mouth-  Wash. 
R .     Tr.  kramerice. 
Boro-glyceride. 

Eau  de  cologne  . aa ^j 

Spts.  vini  rect ad ^  viij  M. 

S. — A  teaspoonful  to  be  added  to  a  little  water. 

For  Inflamed  Gums  and  Mucous  Membrane. 

Thomas. 
R .     Pulv.  krameriae, 

Pulv.  cinnamomi aa ^j. 

Aquce  bullientis f  J  vii. 

Macerate  for  two  hours,  strain,  and  add  sacchari      ^  ij. 
SiGNA. — To  be  used  as  a  gargle. 

LANOLIN 

Lanolin  is  the  natural  fat  of  wool,  and  is  used  as  a  substitute 
for  ordinary  fat  for  local  use.  On  account  of  its  being  analogous 
to  the  natural  fat  of  the  skin,  it  is  supposed  to  be  more  freely 


SOLUTION   OF   CHLORINATED   SODA.  381 

absorbed  by  the  tissues  than  the  ordinary  fats  ;  hence  it  is 
employed  as  a  vehicle  for  remedies  which  are  to  be  absorbed, 
and  for  such  a  purpose  has  been  combined  with  arsenious  acid 
and  hydrochlorate  of  cocaine  in  a  devitalizing  mixture. 

LIQUOR  SOD.E  CHLORATE— SOLUTION  OF  CHLORINATED 

SODA. 

labarraque's  solution. 

Formula. — NaCl,  NaClO. 

Derivation. — Solution  of  Chlorinated  Soda  is  obtained  by 
decomposing  a  solution  of  carbonate  of  sodium  by  one  of 
chlorinated  lime.  It  is  a  transparent  liquid,  of  a  greenish- 
yellow  color,  having  a  faint  odor  of  chlorine  and  a  sharp  saline 
taste. 

Medical  Properties  and  Action. — Solution  of  chlorinated  soda 
internally  is  stimulant,  tonic  and  antiseptic.  Externally  it  is 
a  stimulant,  astringent  and  deodorizer,  and  is  generally  applied 
in  the  form  of  a  lotion. 

Thcrapetitic  Uses. — Solution  of  chlorinated  soda  is  employed 
internally  in  typhus  and  typhoid  and  malignant  scarlet  fevers, 
mesenteric  affections  of  children,  etc.  Externally  it  is  used 
as  an  application  to  all  forms  of  foul  and  indolent  ulcers, 
ulcerations  of  membranes,  ozaena,  coryza,  otorrhoea,  syphilitic 
eruptions  of  scalp  and  other  skin  diseases,  burns,  etc.,  etc.  It 
is  used  diluted,  and  has  an  alkaline  reaction.  It  is  a  powerful 
disinfectant,  and  is  useful  in  all  affections  attended  with  fetor. 
The  concentrated  solution  is  an  irritant  poison  and  caustic  ; 
largely  diluted  it  is  tonic  and  stimulant. 

Dose. — A  solution  of  chlorinated  soda,  gtt.  xxx  to  5j,  diluted, 
several  times  a  day;  it  fulfills  the  same  indications  as  chlor- 
inated lime. 

Dental  Uses. — Solution  of  chlorinated  soda  is  a  valuable 
agent  in  dental  practice  as  a  disinfectant,  deodorizer  and  anti- 
septic. It  is  employed  in  mercurial  stomatitis,  ulcerated  gums, 
fetid  discharges  from  carious  teeth,  and  all  affections  of  the 
mouth  attended  with  fetid  discharge,  and  is  useful  for  its  stim- 
ulating property,  thus  inducing  healthy  action;  also  in  aphtha;, 


382  DENTAL  MEDICINE. 


cancrum  oris,  diseases  of  the  antrum,  necrosis  of  the  bones 
of  the  jaws,  scurvy,  offensive  breath,  and  as  a  bleaching  agent 
for  discolored  teeth,  especially  in  combination  with  powdered 
alum.  It  should  be  kept  in  glass-stoppered  bottles  and  pro- 
tected from  the  light  and  heat. 

DENTAL    FORMULA. 

For  AphthcB  and  Ulceration  of  the  For    Mercurial    Stomatitis ,    Fetid  Dis- 
Mouth  of  Children.  charges  from  Carious  Teeth,  Ulcerated 

R .     Liquor  sodse  chlor.,  <^«'«-f-  ^^'^• 

Myrrhae  .    .    .  aa  .    .    ,  f^ss  R.     Liquor  sodse  chlor,    .    .  fgvj 

Aquae  rosae f|j  Aquae fgxij.  M. 

Aquse f  ^  vj    M.  SiGNA. — To  be  used  as  a  lotion. 

SiGNA. — To  be  used  as  a  lotion. 

For  Offensive  Breath  and  Deodorizer 
For  Mercurial  Stomatitis.  Generally. 

R .     Liquor  sodse  chlor     .    .  §  ss  R  •     Liquor   sodse    chlor. 

Mellis g  ss  (concent.)    ....  gtt.vj  to  x 

Aquse  destillatse        .    •  §x      M.  Aqu£e  pur^ gij.     M. 

SiGNA. — To  be  used  as  a  mouth  wash.  SiGNA. — To  be  used  as  a  gargle. 

For  Phagedenic  and  Sloughing  Ulcers.  p  or  Offensive  Breath. 

R.     Liquor  sodse  chlor   .    .  f  gj  R.     Liquor  sodre  chlor.    .    .  ^j 

Aquse f^viij.  M.  Aquse giv.    M. 

SiGNA. — To  be  applied  as  a  lotion.  SiGNA. — To  be  used  as  a  gargle. 

KINO— KINO. 

Source. — The  inspissated  juice  of  the  Pterocarpus  Marsupium, 
and  of  other  plants.    , 

Medical  Properties  and  Therapeutic  Uses. — With  Krameria, 
Galla,  and  Catechu,  Kino  is  one  of  the  substances  containing 
forms  of  tannic  acid,  and  has  the  same  physiological  action 
and  uses,  being  powerfully  astringent.  The  tincture,  "  Tinc- 
tures Kifto,"  compound  of  ten  parts  of  kino  to  one  hundred 
parts  of  alcohol,  is  the  only  preparation  employed. 

Dose. —  Of  Tinctures  Kino,  ITlx  to  oij.  (See  Tannic  and 
Gallic  Acids,  Krameria.) 

LITHIUM— LITHIUM. 

Source. — From  the  alkali  Lithium,  which  is  rare  in  nature. 
Preparations — Lithii  Carbonas — carbonate  of  lithium,  a  white 


LITMUS.  383 

powder  but  slightly  soluble  in  water,  and  having  a  feeble  alka- 
line reaction. 

Dose. — Grs.  ij  to  grs.  x. 

Lithii  Citras — Citrate  of  Lithium,  a  deliquescent  white  pow- 
der, soluble  in  twenty-five  parts  of  water. 

Dose. — Grs.  v  to  grs.  xxx. 

Lithii  Salicylas. — Salicylate  of  Lithium,  a  deliquescent  white 
powder  with  a  sweetish  taste,  feeble  acid  reaction  and  very 
soluble  in  alcohol  and  water. 

Dose. — Or.  v  to  3j. 

Lithii  Benzoas. — Benzoate  of  Lithium,  either  in  the  form  of 
a  white  powder  or  small,  shining  scales,  not  deliquescent  in 
the  air,  and  having  a  sweetish,  cooling  taste  and  a  feeble  acid 
reaction. 

It  is  soluble  in  twelve  parts  of  alcohol  at  60°  F.,  and  in  four 
parts  of  water. 

Dose. — Gr.  ij  to  gr.  xv. 

Medical  Properties  and  Therapeutic  Uses. — These  lithium 
salts  have  strong  alkaline  properties,  and  produce  effects  sim- 
ilar to  those  of  the  potassium  and  sodium  compounds  ;  and 
hence  are  very  effective  antacid  agents.  The  salts  of  lithium 
are  employed  with  great  benefit  in  rheumatic  gout,  uric  acid 
diathesis,  rheumatism,  uric  acid  calculi  of  kidneys  and  blad- 
der, irritable  bladder  from  an  excess  of  acid  in  the  urine,  etc. 

Dental  Uses. — The  lithium  salts  are  effective  in  preventing 
and  correcting  the  effects  of  a  gouty  diathesis  upon  the  teeth, 
and  in  periodontitis  dependent  upon  gout.  The  carbonate  of 
lithium  is  employed  to  arrest  the  abrasion  or  erosion  of  the 
teeth,  when  due  to  an  excess  of  uric  acid  in  the  saliva ;  for 
such  a  purpose  the  agent  can  be  dissolved  in  carbonic  acid 
water. 

LITMUS— LACMUS. 

Source. — Litmus  is  a  peculiar  coloring  matter  obtained  from 
various  species  of  rocella,  of  the  natural  order  Lichencs — the 
Lichen  order,  which  grow  on  Alpine  or  maritime  rocks  in 
various  parts  of  the  world.  The  varieties  used  for  chemical 
purposes  are  obtained  from  the  European  and  African  coasts 


384  DENTAL   MEDICINE. 


and  Northern  Europe.  They  yield  coloring  substances  by  the 
reaction  of-  water,  air,  and  ammonia.  Litmus  is  prepared 
chiefly  in  Holland ;  the  lichens  being  coarsely  powdered  and 
macerated  for  several  weeks,  with  occasional  agitation  in  a 
mixture  of  urine,  lime  and  potassa  or  soda,  fermentation  en- 
suing ;  the  mass  becomes  first  red  and  ultimately  blue,  and  is 
then  mixed  with  calcareous  or  siliceous  matter,  to  give  it  con- 
sistence. A  tincture  is  formed  from  this  product  (litmus  i  part 
to  distilled  water  20  parts),  and  blue  litmus  paper  is  made  by 
steeping  unsized  paper  in  the  liquid  and  afterwards  drying  it. 
The  blue  tincture  is  rendered  deeper  in  color  by  indigo.  Red 
litmus  paper  is  prepared  in  the  same  manner,  except  that  the 
tincture,  into  which  the  unsized  paper  is  steeped,  is  reddened 
by  the  addition  of  sulphuric  acid. 

Dose. — The  chief  use  of  litmus  in  medicine  and  dentistry  is 
as  a  test  of  acids  and  alkalies ;  blue  litmus  paper  being  turned 
red  by  acids,  while  red  litmus  paper  is  turned  blue  by  alkalies. 
In  dental  practice  litmus  paper  is  employed  to  determine  the 
nature  of  the  oral  fluids — whether  acid  or  alkaline, 

A  single  color,  viz.,  purple,  has  recently  been  substituted 
for  the  ordinary  blue  and  red  litmus  paper.  This  purple 
litmus  paper  turns  red  with  acids,  blue  with  alkalies.  It  is 
claimed  to  be  much  more  delicate  and  convenient. 

LYSOL. 

Derivation. — Lysol  is  obtained  by  boiling  coal  tar  with  fat, 
alkali,  resinous  acid  and  resin,  and  contains  no  phenol,  but 
principally  cresol.  It  is  readily  soluble  in  water,  and  has  a 
strong  pungent  odor.  It  is  of  the  consistence  of  soft  or  pot- 
ash soap,  or  in  the  form  of  a  clear  oily  liquid. 

Lysol  is  a  very  complex  substance  (not  homogeneous),  with- 
out any  definite  formula. 

Medical  Properties  and  Therapeutic  Uses. — It  is  claimed  that 
lysol  is  superior  as  a  germicide  to  corrosive  sublimate,  car- 
bolic acid,  iodoform,  and  creolin,  its  bactericide  properties 
being  very  great.  As  an  antiseptic,  etc.,  in  the  treatment  of 
wounds  a  i  per  cent,  solution  is  employed ;  for  internal  wash- 


LYSOL. 


385 


ings  Yi  per  cent,  solutions  are   recommended.     It  sometimes 
exerts  an  irritant  action  on  the  skin. 

Dr.  F.  Haenel  lays  special  stress  upon  the  simplicity  of  its 
use — a  few  minutes  energetic  brushing  with  the  solution  being 
all  that  is  required  to  prepare  a  surface  for  operation,  instead 
of  the  usually  complicated  process  of  cleaning  and  disinfection 
of  the  skin.  For  this  purpose  Lysol  answers  as  well  as  the 
best  soap,  removing  not  only  visible  dirt,  but  fatty  or  resinous 
spots  on  the  skin,  instruments,  etc.  The  soapy  feeling  it 
imparts  to  the  hands,  instruments,  and  sutures  is  best  avoided 
by  drying  the  hands  and  the  prepared  area  of  operation  with 
a  sterilized  cloth  before  beginning  to  operate. 

With  respect  to  the  bactericidal  properties  of  the  prepara- 
tion Schotellius  found  that  in  15  to  20  minutes  a  one-third  per 
cent,  solution  destroyed  all  kinds  of  germs.  The  investiga- 
tions of  Gerlach  led  to  similar  results,  and  the  experiences  of 
Dr.  F.  Haenel  are  also  in  accordance  with  these  statements. 
He  used  solutions  varying  in  strength  from  Y  to  Y  P^^* 
cent.,  and  on  all  grounds  concludes  that  Lysol  is  superior  to 
sublimate,  carbolic  acid,  iodoform,  and  the  other  ordinary  an- 
tiseptics, either  by  virtue  of  its  non-poisonousness,  or  odor- 
lessness,  or  the  clearness  of  its  solutions.  It  forms,  he  points 
out,  clear  mixtures  with  distilled  water,  or  with  ordinary  water 
which  does  not  contain  much  chalk.  In  solutions  made  with 
spring  or  tap  water  which  contains  much  lime,  a  turbidity 
appears  which  increases  in  the  progress  of  time,  and  is  less 
conspicuous  in  strong  than  in  weak  solutions.  As  the  disin- 
fectant constituents  remain  in  solution,  the  bactericidal  action 
of  the  liquid  is  in  no  way  prejudiced.  For  some  purposes, 
this  turbidity  is  a  disadvantage,  however,  and  the  author  states 
that  the  best  way  to  avoid  it,  is  to  prepare  the  solutions  imme- 
diately before  use,  if  necessary,  to  avoid  the  employment  of 
the  weaker  dilutions. 

Dental  Uses. — Lysol  may  be  employed  in  dental  practice  as 
an  antiseptic,  disinfectant,  and  germicide  in  the  case  of  putre- 
scent or  gangrenous  pulps,  to  disinfect  root-canals,  and  carious 
cavities  of  teeth  ;  also  in  the  form  of  a  i  per  cent,  solution  for 
25 


386  DENTAL   MEDICINE. 


unhealthy  wounds  and  ulcers  of  the  oral  mucous  membrane, 
upon  which  it  has  an  astringent  effect.  It  is  advisable  to  em- 
ploy lysol  in  from  ^  to  i  per  cent,  solution  whenever  an  an- 
tiseptic or  aseptic  operation  is  desired. 

MAGNESIA— CALCINED  MAGNESIA. 

Formula.  — M  gO. 

Derivation. — Magnesia  is  obtained  by  exposing  carbonate  of 
magnesium  to  a  red  heat,  and  thus  expelling  all  of  the  car- 
bonic acid,  which  is  shown  by  a  want  of  effervescence  on  the 
addition  of  dilute  sulphuric  acid.  It  is  very  light,  and  of  white 
color  and  odorless,  and  in  the  form  of  powder,  with  an  earthy 
taste,  and  slightly  soluble  in  water,  more  so  in  cold  than  in 
hot  water. 

Medical  Properties  and  Action. — Magnesia  is  antacid  and 
laxative,  its  laxative  effect  being  the  result  of  the  combination 
it  forms  with  the  free  acids  of  the  stomach  and  intestines. 
After  its  effects  are  exerted  in  the  intestinal  canal,  it  becomes 
absorbed  and  renders  the  urine  alkaline.  Large  doses,  when 
administered  for  a  considerable  time,  may  accumulate  in  the 
bowels ;  such  an  effect  may  be  avoided  by  administering  it 
with  lemonade,  which  renders  it  more  soluble.  Being  mild 
and  unirritating,  it  is  well  adapted  for  children,  and  is  an  ex- 
cellent remedy  for  great  acidity  in  the  stomach.  It  is  the 
antidote  in  poisoning  by  the  mineral  acids. 

Therapejitic  Uses. — Magnesia  is  administered  in  acidity  of 
the  stomach,  heartburn,  sick  headache  and  kidney  affections, 
as  an  antacid,  and  in  combination  with  other  agents  in  the 
diarrhoea  of  children.  It  is  also  an  efficient  aperient,  alone  or 
in  a  little  milk. 

Dose. — Of  magnesia,  as  a  laxative,  gr.  x  to  5j ;  as  an  ant- 
acid, 3j.  Of  a  preparation  known  as  "  Henry's,"  the  dose  is 
half  the  quantity  just  given. 

Dental  Uses. — Magnesia  is  employed  in  dental  practice, 
chiefly  for  its  antacid  properties,  as  an  ingredient  of  dentifrices ; 
in  solution  in  the  form  of  a  gargle,  to  counteract  the  effect  of 
acid  medicines  upon  the  teeth ;  also  as  an  ingredient  of  reme- 


SULPHATE  OF   MAGNESIUM.  387 

dies  for  infantile  diarrhcea  during  the  period  of  dentition;  and 
also  to  change  an  acid  condition  of  the  oral  fluids,  by  being 
rubbed  between  the  teeth  and  permitted  to  remain  for  a  short 
time. 

DENTAL  FORMULAE. 

For  Infantile  Bilious  Diarrhcea.  For  Infantile  Mucous  Diarrhxa. 

CONDIE.  EhERLE. 

R .     Magnesi^E  calc  .    .    .  gr.xxiv  g .     Magnesia   calc  ....  gr.x 

Calomel grij-iij  Bals.  copaiba 3J 

Ipecacuanha.    .    .    .  gr.ij-iij  Spir.   sether'nit.    .    .    .  jiij 

Ext.  hyoscyami  .    .    .  gr.iv-vj.  M.  Sacch.  alb '7,\) 

F.  ch.  No.  xij.  Aq.  cinnamon ^iij.  M, 

SiGNA.— One  to  be  given  every  two  or       Signa.— A   teaspoonful    every   two    or 
three  hours.  three  hours ;  each  dose  to  be  followed 

in  the  course  of  an  hour  by  the  fifth 
of  a  grain  of  Dover's  Powder. 

magnesii  sulphas— sulphate  of  magnesium, 
(epsom  salt). 

Formula. — MgS047H20. 

Derivation. — Epsom  Salt  is  obtained  by  the  action  of  sul- 
phuric acid  on  magnesite,  the  siliceous  hydrate  of  magnesium. 
It  is  in  the  form  of  small,  colorless  crystals,  which  effloresce 
on  exposure  to  the  air,  and  are  very  soluble  in  water.  It  is 
odorless,  but  has  a  very  bitter  taste. 

Medical  Froperties  and  Action. — Sulphate  of  magnesia  is  a 
refrigerant  purgative,  safe  and  mild  in  its  action,  and  is  per- 
haps more  commonly  employed  as  a  cathartic  than  any  other. 
It  is  at  times  combined  with  other  agents. 

Therapeutic  Uses. — Sulphate  of  magnesia  is  administered  as 
a  saline  purgative  in  acute  inflammatory  and  febrile  affections, 
to  depress  the  arterial  tension,  and  also  to  relieve  the  kidneys 
where  they  are  hypcra^mic;  hence  it  is  a  valuable  remedy  in 
renal  and  cardiac  dropsy,  constipation  of  lead  colic,  acute 
dysentery,  dyspepsia  with  constipation,  etc.,  etc. 

Dose.  —  Oi  sulphate  of  magnesia,  5j  to  Sj,  in  water  or  car- 
bonic acid  water. 

Dental  Uses. — Sulphate  of  magnesia  is  employed  internally 


388  DENTAL   MEDICINE. 

in  dental  practice,  to  reduce  the  arterial  tension  in  acute  in- 
flammation^ of  the  dental  organs,  such  as  acute  pulpitis,  acute 
periodontitis,  etc. 

To  disguise  the  bitter  taste  of  Epsom  salts,  the  following 
formula  may  be  employed  : — 

R.     Magnesii    sulphatis J^v 

Essentias  menthse gtt.iij.     M. 

DENTAL  FORMULA, 
For  Dysuria  of  Difficult  Dentition. 

R .     Sulph.  magnes 5  ij  to  5  iij 

Aquae  puras ^j  dein  adde 

Spir.  Eether.  nitrici 3  ij 

Tinct.   opii Tll'^^j  *^o  ^^-  ^• 

SiGNA. — A  teaspoonful,  to  be  repeated  according  to  circumstances. 

MATICO. 

Source. — Matico — maticce  folioe ,  are  the  dried  leaves  of  the 
shrub  artanthe  elongata,  of  the  natural  order  Piperacece — pep- 
per order,  and  is  a  native  of  Peru.  They  are  from  two  to 
eight  inches  long  by  an  inch  in  breadth,  strongly  reticulated, 
and  of  a  bright  green  on  the  upper  surface  and  lighter  in  color 
beneath  when  fresh,  with  an  agreeable  aromatic  odor  and  a 
strong  astringent  taste.  They  contain  a  trace  of  tannic  acid, 
a  peculiar  acid,  artanthic,  a  volatile  oil,  resin,  and  a  very  bitter 
pri  nciple — inaticin . 

Medical  Properties  mid  Action. — Matico  is  an  aromatic  tonic, 
an  alterative  stimulant,  an  internal  haemostatic  and  local  styp- 
tic. It  has  a  special  determination  to  the  mucous  membranes, 
and  although  as  an  internal  remedy  its  astringent  properties 
are  not  so  well  marked,  it  acts  externally  as  a  reliable 
haemostatic  and  styptic.  The  powder  made  from  the  under 
side  of  the  leaf  is  more  powerfully  styptic  than  that  from  the 
upper  side. 

Therapeutic  Uses. — Matico  in  the  form  of  powder,  infusion 
and  fluid  extract,  is  employed  in  internal  hemorrhages,  epis- 
taxis,  atonic  diarrhoea  and  diseases  of  the  urinary  passages, 
etc. ;  externally  as  a  haemostatic  in  superficial  hemorrhages, 
and  also  in  leucorrhoea,  in  the  form  of  an  injection. 


MENTHOL.  339 


Dose. — Of  powdered  matico,  5ss  to  5j,  three  times  a  day; 
of  the  infusion  the  dose  is  fgij  ;  of  the  fluid  extract  the  dose 
is  f5ss  to  foj. 

Dental  Uses. — The  powder  and  tincture  are  valuable  styp- 
tics in  hemorrhage  following  the  extraction  of  teeth,  hemor- 
rhage from  leech  bites  and  superficial  wounds  of  mucous 
membrane. 

MENTHOL— JAPANESE  CAMPHOR. 

(peppermint  camphor.) 

Formula. — CiqHjoO. 

Derivation. — Menthol  is  the  stearoptene  of  peppermint  oil, 
and  is  obtained  from  this  oil  either  by  long  keeping  or  by 
being  cooled  at  a  low  temperature.  Chemically,  menthol 
occupies  the  position  of  an  alcohol,  having  in  its  composition 
four  atoms  more  of  hydrogen  than  the  ordinary  camphor,  and 
containing  the  radical  menthyl.  It  is  in  the  form  of  a  crystal- 
line solid,  composed  of  small  white  crystals  of  a  peppermint 
odor  and  resembling  sulphate  of  magnesia.  It  is  imported  as 
Japanese  camphor,  its  chief  source  being  the  Japanese  and 
Chinese  peppermint  oils.  In  a  liquid  state  it  has  a  specific 
gravity  less  than  that  of  water.  It  is  rendered  liquid  and 
volatile  at  a  temperature  one  or  two  degrees  below  that  of  the 
body.  It  is  sparingly  soluble  in  cold  water,  liquefying  slowly 
in  water  at  82°  F.,  quickly  at  120°  F.,but  remains  mostly  as  a 
separate  body.  It  is  freely  soluble  in  alcohol,  ether,  glycerine, 
and  in  the  fixed  and  volatile  oils. 

Medical  Properties  and  Action. — Menthol  is  anodyne,  anti- 
spasmodic, and  antiseptic.  In  doses  of  gr.  yV  to  \  it  steadies 
the  contractions  of  an  excited  heart,  and  causes  tranquillitj', 
and  at  the  same"  time  slight  cerebral  drowsiness. 

Half  a  grain  may  cause  vomiting  from  gastric  irritation, 
hence  care  should  be  observed  in  its  administration,  either 
internally  or  externally,  about  the  mouth.  Its  internal  use  is 
not  advocated,  unless  well  diluted,  but  its  principal  use  is  as 
an  external  application. 

Therapeutic  Uses. — Menthol  is  said  to  prove  as  effectual  as 


390  DENTAL  MEDICINE. 


aconite,  veratria  and  atropine  for  such  diseases  as  neuralgia, 
brachalgia  and  gout ;  more  so  it  is  claimed  by  some.  It  is 
also  used  in  chronic  rheumatism  and  in  headache.  It  is  also 
applied  to  putrefactive  wounds,  as  an  antiseptic. 

Dental  Uses. — In  dental  practice,  menthol  has  given  satis- 
faction as  an  external  remedy  in  facial  neuralgia,  odontalgia, 
as  an  obtunder  of  sensitive  dentine,  and  as  a  local  anaesthetic. 
For  relieving  the  pain  of  sensitive  dentine,  a  small  portion  of 
the  crystals  is  applied  to  the  sensitive  surface,  and  in  a  few 
minutes  the  local  anaesthetic  effect  is  produced.  As  an  anti- 
septic it  has  been  employed  in  the  treatment  of  decomposing 
pulps  of  teeth,  necrosed  teeth,  etc.  When  applied  to  mucous 
surfaces  for  its  anaesthetic  effect,  a  twenty  to  thirty  per  cent, 
solution  is  used,  but  it  is  more  evanescent  than  cocaine. 
Menthol  also  forms  an  ingredient  of  a  devitalizing  mixture. 

The  oil  of  the  ordinary  peppermint  is  considered  to  be  a 
germicide  and  antiseptic  of  considerable  power  and  rapidity. 
It  is  readily  diffusible,  does  not  evaporate  quickly,  and  is  non- 
poisonous.  It  is  useful  in  root  canals  and  fistulous  tracts  after 
removal  of  pulps,  and  for  hypersensitive  dentine. 

DENTAL  FORMULAE. 

For  Facial  Neuralgia  and  Odontalgia.  por  Neuralgia  and  Odontalgia. 

R .     Menthol gr.  j  R .     Menthol gr.  v 

Spts.  vini  rectificati     .    .  TTLJ  Olei  caryophylli  (or  oil  of  caje- 

Olei  caryophylli    .    ,    .  D^x.     M.  put) f  3  j.  M. 

SiGNA.— For  facial   neuralgia,   painted  SiGNA.— To  be  painted  on  affected  part, 

on  the  affected  part.    For  odontalgia,  or,  for  odontalgia,  applied  on  cotton, 
applied  on  cotton  to  carious  cavity. 

LOCAL   ANESTHETIC. 
For  Abscesses,  Boils,  Felons,  etc. 

R .     Qiloroformi "Z^v 

Ether  sulphurici ^  j 

Menthol ^ss.     M. 

SiGNA. — Use  with  spray  apparatus. 

METHYLENE— BICHLORIDE  OF  METHYLENE. 

Formula.— CYiQ\  X  Hg  =  CH2CI2  X  HCl. 
Derivation. — Methylene  is  obtained  by  the  action  on  chloro- 
form of  nascent  hydrogen.     It  boils  at  104°  F.  and  40°  C.  and 


BICHLORIDE  OF  METHYLENE.  391 

is  a  colorless,  volatile  liquid  with  the  odor  of  chloroform.  It 
was  introduced  in  1840  by  Dr.  B.  W.  Richardson.  It  is 
pleasant  to  inhale  in  the  form  of  vapor.  Its  specific  gravity  is 
1.344,  and  evaporates  more  easily  than  chloroform,  and  the 
vapor  being  denser,  it  requires  a  less  quantity  than  ether.  It 
is  soluble  in  alcohol  and  ether  and  is  frequently  combined  with 
other  agents  to  lessen  its  cost. 

Medical  Properties  and  Therapeutic  Uses. — Methylene  pos- 
sesses many  of  the  dangerous  qualities  of  chloroform  when 
used  as  a  general  anaesthetic,  and  death  results  from  syncope 
with  dilated  pupils.  It  was  a  favorite  anaesthetic  with  Dr. 
Richardson,  and  Sir  Spencer  Wells  believes  that  it  has  all  the 
advantages  of  complete  anaesthesia  with  fewer  drawbacks  than 
any  other.  He  gives  it  diluted  with  air  by  Junker's  apparatus, 
and  it  is  supposed  that  he  employs  a  mixture  of  methylic  alco- 
hol and  chloroform. 

Despite  the  fact  that  so  eminent  a  surgeon  as  Sir  T.  Spencer 
Wells  uses  methylene  as  an  anaesthetic,  and  has  continued  to 
advocate  its  use  for  twenty  years,  very  few  have  followed  his 
example.  This  is  because  the  statistics  of  mortality  from  this 
anaesthetic  apparently  show  it  to  be  considerably  more  danger- 
ous than  ether. 

A  recent  fatal  case  at  the  Plymouth  Hospital  has  called  out 
a  letter  from  Sir  Spencer,  in  which  he  states  that  this  and 
other  accidents  have  been  due  to  improper  administration. 
He  says :  "  I  have  never,  either  in  hospital  or  private  practice, 
since  I  began  to  operate  in  1870  under  methylene,  seen 
anything  approaching  to  danger  under  its  influence,  nor  have 
I  had  a  moment's  uneasiness  or  apprehension  such  as  I  have 
repeatedly  suffered  during  the  administration  of  chloroform, 
ether,  the  A.  C.  E.  mixture,  laughing-gas  followed  by  ether, 
or  the  mixtures  of  chloroform  and  alcohol  which  some 
have  supposed  to  be  identical  with,  or  substitutes  for,  methy- 
lene. And  it  is  very  seldom  that  in  the  most  prolonged  opera- 
tions— say,  for  an  hour — more  than  from  six  to  eight  drachms 
of  methylene  are  used ;  while  I  have  repeatedly  found  that  in 
operations  of  fifteen  or  twenty  minutes,  not  more  than  from 
two  to  three  drachms  have  been  evaporated." 


392  DENTAL   MEDICINE. 


METHYLIC  ETHER— METHYL-ETHYLIC  ETHER. 

Formula. — ( C  H  2)20 . 

Derivation. — Methylic  Ether  is  obtained  by  digesting  methy- 
lic  alcohol  with  strong  sulphuric  acid.  It  is  a  gaseous  sub- 
stance, of  an  ethereal  odor,  and  under  the  name  of  methyl-ethylic 
ether,  it  has  been  used  as  a  general  anaesthetic.  The  methylic 
ether  is  prepared  for  use  as  methyl-ethylic  ether  by  frequent 
washings  in  a  strong  solution  of  potassa,  and  is  afterwards  dis- 
solved in  absolute  ethylic  ether.  In  order  that  it  may  be  fit  for 
use  it  is  necessary  to  keep  it  for  some  time  securely  stopped. 

Dental  Uses. — According  to  Dr.  B.  W.  Richardson,  of  Eng- 
land, methylic  ether  is  a  superior  anaesthetic  for  dental  opera- 
tions— better,  he  says,  than  nitrous  oxide  gas,  because  it  allows 
air  to  be  given  with  it,  and  does  not  asphyxiate  nor  produce 
muscular  spasms  and  syncope.  Under  its  influence  the  patient 
is  in  a  state  of  semi-consciousness,  but  is  not  conscious  of 
pain  from  an  operation. 

MICROCIDIN— MICROCIDINE. 

Detivation. — Microcidin  is  a  combination  of  naphthol  and 
soda.  Naphthol  25  per  cent,  and  sodium  naphtholate  75  per 
cent.,  one  part  being  soluble  in  three  parts  of  water.  Micro- 
cidine  does  not  corrode  instruments  or  dressing  materials,  and 
is  without  odor  or  taste. 

Medical  Properties  and  Therapeutic  Uses. — Microcidin  has 
a  very  feeble  toxicity,  is  caustic  in  large  quantities,  but  in 
medicinal  doses,  even  the  largest  required,  is  not  irritating 
when  applied  to  wounds  as  an  antiseptic  and  disinfectant ;  it 
may  also  be  used  for  toilet  purposes.  It  reduces  fever  rapidly, 
and  is  excreted  by  the  urine,  which  is  rendered  aseptic.  It 
has  been  employed  successfully  in  a  large  number  of  cases  of 
infected  and  operative  wounds.  It  is  used  in  aqueous  solution 
in  the  strength  of  5  to  1000  (strong  solution)  and  3  to   1000. 

Dental  Uses. — As  an  antiseptic  and  disinfectant,  microcidin 
may  be  employed  in  dental  practice  on  gangrenous  pulps,  cari- 
ous cavities  in  pulp-canals,  and  wounds  and  ulcers  of  mucous 
membrane ;  and  as  a  disinfectant  and  antiseptic  generally. 


MORPHINE.  393 


MORPHINA— MORPHINE. 

Formula. — C17H19NO3,  H2O. 

Derivation. — Morphine  is  the  alkaloid  which  constitutes  the 
chief  narcotic  principle  of  opium,  the  proportion  varying  from 
10  to  15  per  cent.  It  is  present  in  opium  in  combination  with 
meconic  acid  and  the  meconate  of  morphia  is  separated  by- 
repeated  macerations  with  water,  after  which  the  salt  is  decom- 
posed by  alcohol  and  water  of  ammonia,  the  latter  precipitating 
the  morphine  and  the  former  taking  up  the  coloring  matter  as 
soon  as  it  is  freed  from  the  alkali.  The  crystals  of  morphine 
are  then  boiled  in  alcohol  and  the  solution  filtered  through 
animal  charcoal.  Morphine  is  in  the  form  of  white,  or  color- 
less crystals,  which  are  inflammable  and  freely  soluble  in  boil- 
ing alcohol,  scarcely  soluble  in  cold  water,  and  somewhat  so 
in  boiling  water.  The  salts  of  morphine,  however,  are  freely 
soluble  in  water.  It  is  without  odor,  and  has  a  very  bitter 
taste.  Morphine  differs  somewhat  in  its  mode  of  action  from 
opium,  which  may  arise  from  the  peculiar  state  of  combination 
in  which  it  exists  in  opium.  Morphine  is  more  insoluble 
than  its  salts,  and  for  this  reason  the  latter  are  preferred  for 
administration. 

Medical  Properties  and  Action. — Morphine  is  more  powerful 
than  opium  ;  but  it  causes  less  vascular  and  arterial  excite- 
ment, less  headache  and  vertigo,  less  subsequent  depression, 
less  constipation,  and  often  it  will  be  retained  on  an  irritable 
stomach,  when  opium  or  its  tincture  (laudanum)  would  be 
rejected. 

Morphine  is  indicated  when  the  object  is  to  relieve  nervous 
irritability  and  induce  tranquillity.  The  effects  of  morphine 
differ  according  to  the  peculiarities  of  nervous  constitution. 
The  hypnotic  effect  may  be  produced  and  the  stimulant  action 
be  confined  to  the  heart;  in  some  cases  the  excitant  effect  pre- 
vails, or  the  two  effects  may  be  equal.  The  excitant  effect 
may  counteract  the  hypnotic  effect  to  a  greater  or  less  degree, 
resulting  in  insomnia  with  restlessness,  or  even  delirium. 
Females  appear  to  be  more  liable  to  its  excitant  effects  than 
males;  and   if  there  is  present  a  highly  emotional,  excitable 


394  DENTAL   MEDICINE. 


and  energetic  temperament,  it  causes  great  distress,  and  danger- 
ous effects  when  hypodermically  administered. 

Therapeutic  Uses. — Morphine,  in  the  form  of  salts,  is  em- 
ployed as  an  anodyne  and  hypnotic  in  neuralgic  affections, 
diseases  of  the  heart,  painful  uterine  affections,  and  in  all  cases 
of  painful  affections.     (See  Opium.) 

The  principal  salts  of  morphine  are  the  acetate,  the  hydro- 
chlorate  and  the  sulphate. 

MORPHINE  ACETAS — ACETATE  OF  MORPHINE. 

Formula. — CiyHjgNOg,  HCgHgOg. 

Derivation. — Acetate  of  Morphine  is  obtained  by  precipi- 
tating morphine  from  the  hydrochlorate  of  morphine,  by  the 
aid  of  ammonia,  the  precipitate  resulting  being  washed  in 
distilled  water  and  dissolved  and  neutralized  by  acetic  acid, 
after  which  it  is  evaporated  and  dried  by  heat.  It  is  in  the  form 
of  a  white  or  yellowish- white,  amorphous  or  crystalline  powder, 
altogether  soluble  in  water  and  alcohol,  and  of  a  bitter  taste. 

MORPHINE  HYDROCHLORAS  OR  MURIAS HYDROCHLORATE  OR 

MURIATE  OF  MORPHINE. 

Formula.— Z^^YiJ^O^,  HCl  3H2O 

Derivation. — Hydrochlorate  or  Muriate  of  Morphine  is  ob- 
tained by  macerating  opium  in  distilled  water,  evaporating  to 
a  small  quantity,  and  adding  chloride  of  lime,  and  concen- 
trating the  solution  until  it  becomes  solid  when  cool,  after 
which  it  is  pressed,  washed  with  distilled  water,  again  evapor- 
ated, cooled  and  pressed,  and  again  dissolved  in  distilled  water, 
when  it  is  subjected  to  animal  charcoal,  to  remove  the  color- 
ing matter,  filtered  and  precipitated  by  ammonia,  the  codeia  of 
the  opium  remaining  in  solution.  The  crystals  resulting  are 
then  dissolved  in  muriatic  acid,  and  the  morphine  allowed  to 
crystallize  into  hydrochlorate  or  muriate  of  morphine.  It  is 
in  the  form  of  snow-white,  feathery,  flexible  and  acicular  crys- 
tals, of  a  bitter  taste  and  silky  lustre,  and  altogether  soluble 
in  water  and  alcohol. 


MORPHINE.  395 


MORPHIN.E    SULPHAS — SULPHATE    OF    MORPHINE. 

Fon;m/a.—C,.U,gNO^,  2H.SO,,  5H2O. 

Derivation. — Sulphate  of  Morphine  is  obtained  by  dissolving 
morphine  in  boiling  alcohol,  and  saturating  it  while  hot  with 
sulphuric  acid,  the  coloring  matter  being  removed  by  animal 
charcoal ;  it  is  then  boiled  and  filtered  while  at  the  boiling 
temperature.  Upon  cooling  the  sulphate  is  deposited  in  the 
form  of  white,  feather}',  acicular  crystals,  of  a  silky  lustre, 
odorless,  with  a  bitter  taste  and  a  neutral  reaction.  It  is  sol- 
uble in  water  and  alcohol. 

Medical  Properties  and  Action  of  the  Salts  of  Morphine.  — 
The  salts  of  morphine  possess  anodyne,  hypnotic  and  antispas- 
modic properties,  and  are  less  stimulating,  less  convulsant,  and 
more  hypnotic  and  anodyne  than  opium,  and  they  also  pro- 
duce less  constipation,  and  less  diaphoretic  action  than  opium. 
After  the  administration  or  insertion  of  the  ordinary  dose, 
which  is  one-sixth  to  one-fourth  of  a  grain,  there  is  experi- 
enced a  sense  of  heat  and  flushing  of  the  face,  which  may  be 
preceded  by  some  pallor,  a  fullness  of  the  head,  giddiness, 
noise  in  the  ears,  and  frequently  nausea,  sometimes  epigastric 
pain.  The  vertigo  may  cause  a  staggering  walk  and  inability 
to  maintain  an  upright  position.  Injection  of  the  conjunctiva 
and  contraction  of  the  pupils  occur  at  the  same  time  that  the 
cerebral  effects  are  felt.  The  lips  have  a  bluish  appearance, 
the  mouth  and  tongue  dry,  deglutition  is  painful  and  the  voice 
becomes  husky.  During  these  symptoms  the  anodyne  effects 
are  manifested  by  the  relief  of  pain  and  spasm,  with  perfect 
calmness  of  mind  and  tranquillity.  While  the  effect  is  gene- 
rally hypnotic,  yet  in  some  cases  there  is  extreme  wakeful- 
ness, with  great  mental  activity,  and  when  sleep  occurs,  instead 
of  its  being  calm,  the  respirations  are  slow,  noisy  and  labored, 
the  patient  being  disturbed  by  dreams  and  visions.  While 
the  action  of  the  heart  is  diminished  in  frequency,  there  is  a 
considerable  rise  in  the  arterial  tension.  When  a  hypodermic 
injection  of  morphine  has  been  made,  there  is  experienced  an 
itching  of  the  nose,  which  may  extend  to  the  entire  cutaneous 
surface.     The  skin,  which  is  at  first  dry,  becomes  moist,  from 


396  DENTAL   MEDICINE. 


diaphoresis,  which  is  sometimes  profuse.     The  secretions  of 
the  mucous  surface  are  also  arrested  as  a  primary  effect. 

If  morphine  is  administered  after  a  full  meal,  its  effect  is  to 
suspend  digestion  for  some  time,  and  also  to  temporarily  arrest 
the  intestinal  movements  and  diminish  the  urinal  discharge, 
and  make  its  emission  difficult  on  account  of  the  temporary 
loss  of  contractile  power  of  the  bladder  and  of  the  ejaculatory 
muscles.  When  the  narcotic  effects  of  morphine  decline, 
there  is  generally  experienced  headache,  confusion  of  mind, 
anorexia  and  nausea.  When  a  poisonous  dose  is  adminis- 
tered, a  profound  state  of  narcotism  quickly  ensues,  the  pulse 
becomes  slow  and  feeble,  the  respiration  slow  and  indistinct, 
the  skin  cold  and  covered  with  perspiration,  the  face  pale, 
blue  and  ghastly,  the  conjunctiva  deeply  injected,  the  pupils 
greatly  contracted,  the  reflex  movements  entirely  destroyed. 
Half  a  grain  of  morphia  is  the  smallest  dose  which  has 
proved  fatal  to  an  adult,  but  other  cases  are  recorded  where 
one  grain  destroyed  life.  It  chiefly  affects  the  cerebro-spinal 
functions,  and  causes  death  by  paralyzing  the  respiratory 
muscles. 

The  antidotes  in  cases  of  poisoning  are  the  stomach  pump, 
emetics,  cold  effusions,  counter-irritation,  strong  coffee,  active 
stimulants,  atropine  by  hypodermic  injection,  electro-mag- 
netism, and  artificial  respiration. 

Therapeutic  Uses. — The  salts  of  morphine  are  employed  in 
all  neuralgic  affections,  for  the  relief  of  pain  from  whatever 
cause,  and  to  induce  sleep ;  also  in  diseases  of  the  heart, 
chronic  gastritis,  delirium  tremens,  tetanus,  colic,  spasms,  dys- 
entery, cholera,  cough  of  pulmonary  affections,  cerebro-spinal 
meningitis,  puerperal  fever,  convulsive  diseases,  vomiting, 
cohca  pictonum,  diarrhoea,  diabetes,  gangrene,  etc.,  etc.  For 
hypodermic  injection,  the  acetate  of  morphine  is  supposed  to 
possess  some  advantages  over  the  other  salts,  such  as  the 
sulphate  and  muriate,  one  of  which  is  its  greater  solubility. 
Morphine  is  contra-indicated  where  there  is  a  tendency  to 
apoplexy  or  coma. 

Dose. — Of  the   salts    of  morphine,    gr,   |-   to    gr.  \.     One 


MORPHINE. 


397 


sixth  of  a  grain  of  either  of  the  salts  of  morphine  is  equivalent 
to  a  grain  of  opium,  or  twenty-five  drops  of  the  tincture  of 
opium  (laudanum). 

For  hypodermic  injections  the  dose  of  salts  of  morphine 
is  gr.  I  to  |.  The  use  of  morphine  hypodermically  frequently 
leads  to  the  morphine  habit,  which,  once  formed,  is  rarely 
abandoned ;  and  which,  independent  of  its  fatal  systemic 
effects,  has  very  injurious  effects  upon  the  teeth — the  enamel 
and  dentine  becoming  thoroughly  disintegrated,  owing  to  the 
presence  of  erosive  acids. 

For  endermic  application,  gr.  ^  to  j  of  morphine  may  be 
sprinkled  on  a  surface  (which  has  been  blistered  to  remove 
the  cuticle)  over  the  seat  of  pain ;  but  the  hypodermic  method 
is  the  most  effectual. 

DeJital  Uses. — For  dental  use  the  acetate  of  morphine  and 
the  muriate  of  morphine  are  preferable  to  the  sulphate,  on 
account  of  their  greater  solubility  and  greater  chemical  affin- 
ity with  the  tissues  on  which  they  are  to  act.  The  acetate  of 
morphine  is  also  preferred  to  the  other  salts  as  an  ingredient 
of  nerve  paste  for  destroying  the  vitality  of  the  pulps  of  teeth, 
on  account  of  its  chemical  and  mechanical  compatibility  with 
the  pulp  tissue,  giving  relief  as  an  anodyne  when  the  sulphate 
would  irritate.  Concerning  the  action  of  morphine  when  com- 
bined with  arsenious  acid,  its  effect  is  anodyne,  modifying  the 
irritant  action  of  the  arsenic,  and  preventing  to  a  considerable 
degree  the  intense  pain  which  follows  its  application  to  vital- 
ized structures.  Besides  its  use  in  devitalizing  mixtures  and 
as  an  obtunder  of  sensitive  dentine,  morphine  is  employed  for 
the  temporary  relief  of  odontalgia,  for  such  a  purpose  being 
combined  with  carbolic  acid,  sweet  spirits  of  nitre,  oil  of  cloves 
and  other  anodyne  agents. 

A  paste  made  of  acetate  of  morphine  and  creasote  (or  car- 
bolic acid)  is  much  used  for  obtunding  the  sensitiveness  of 
dentine.  A  thin  paste,  made  of  acetate  of  morphine  rubbed 
up  with  oil  of  cloves  is  an  excellent  application  for  exposed 
pulps;  also  a  mixture  of  acetate  of  morphine,  grs.  v;  oil  of 
cajeput,  foj ;    applied  on  a  pledget  of  cotton.     The  latter  is 


398  DENTAL   MEDICINE. 


also  effective  for  the  pain  following  tooth  extraction ;  it  is  ap- 
plied on  cotton  in  the  alveolar  cavity. 

For  internal  administration  in  facial  and  other  neuralgias, 
morphine  is  combined  with  atropine  in  the  proportion  of 
atropine,  gr.  y^  to  i^;  morphine,  gr.  ^  to  ^;  hypodermi- 
cally  injected.  Morphine  in  combination  with  carbolic  acid  is 
also  employed  to  relieve  the  pain  of  an  exposed  and  painful 
pulp. 

DENTAL   FORMULA. 
J^or  Odontalgia. 

White.  ^°^  Devitalizing  Pulps  of  Teeth. 

R .     Morphine  acetatis  .  .    .  gr.xx  jj  _     MorphinEe  acetatis   .    .  gr.j 

Olei  caryophylli  Acidi  arseniosi ....  gr.ij 

Spiritus     setheris    nitro-  Creasoti q.s.        M. 

SI  .    .    .    .  aa.   .    .    .  31J.  M.           Fiat  massa. 

SiGNA.-Apply  on  a  pellet  of  cotton.  SiGNA.-Apply  a  sufficient  quantity  to 

For    Odontalgia.  exposed  surface  of  pulp,  on  cotton. 
R .     Morphinse  acetatis  .  .    .gr.xx 

Creasoti   (vel  acidi  car-  ^       .,       ?  j  c-     r  ^  n/r    jl 

^  For  Abraded  !:Mrfaces  of  Mouth. 

bolici) ^ij.      M. 

SiGNA. — Apply  to  carious  cavity  on  a  ^^'  ^-  ^-  Hugenschmidt. 

pellet  of  cotton.  To  prevent  friction. 

For  Itching  of  Inflamed  Surfaces.  R  •     Morphinse  murias  .  .    .  gr.ij 

R .     Morphinse  sulph.  .    .    .  gr.vj  Mur.  cocaini    ....  gr.ij 

Sodii  boratis gss  Sodii  boras 3J 

AquEerosce fgviij.M.  Mellis |j.        M. 

Signa. — To  be  used  as  a  lotion. 

To  Relieve  the  Pain  following  the  Extraction  of  Teeth  and  a  Local  Ancesthetic. 

R.    Moi-phinse gr.vj 

Tincture  aconiti, 
Chloroformi, 

Alcoholis aa f^j.         M. 

Signa. — Apply  on  cotton,  or  with  an  applicator,  as  a  local  anaes- 
thetic. 
(See  Formulae  under  Arsenious  Acid.) 

MYRRHA— MYRRH. 
Source. — Myrrh  is  a  gum-resinous  exudation  from  a  small, 
shrubby  tree — Balsamodendron  Myrrha,  of  the  natural  order 
Ainyridace(B,  growing  in  Arabia  and  the  northeastern  coast  of 
Africa.  It  is  obtained  in  the  form  of  small,  irregular  frag- 
ments or  tears,  or  in  larger  masses,  composed  of  agglutinated 


MYRRH.  399 

portions.  The  juice  exudes  spontaneously  from  the  stem  of 
the  tree,  and  concretes  upon  the  bark.  When  pure,  myrrh  is 
of  a  reddish-yellow  or  reddish-brown  color,  translucent,  with 
a  strong,  peculiar  fragrant  odor  and  a  bitter  aromatic  taste, 
brittle  and  pulverizable,  Its  powder  is  of  a  light  yellow  color; 
when  of  a  dark  color  it  is  impure.  When  powdered  myrrh 
is  rubbed  up  for  fifteen  minutes  with  an  equal  weight  of 
muriate  of  ammonia  and  fifteen  times  its  weight  of  water  gradu- 
ally added,  and  it  dissolves  quickly  and  entirely,  it  may  be 
considered  pure. 

Medical  Properties  and  Action. — Myrrh  is  stumulant,  astrin- 
gent, expectorant  and  emmenagogue.  It  stimulates  the  digest- 
ive organs  and  improves  the  appetite.  In  large  doses  of  a  half 
ounce,  it  causes  a  burning  sensation  in  the  stomach,  increased 
arterial  excitement,  and  profuse  diaphoresis,  with  a  great  influ- 
ence on  the  urinary  passages.  It  diminishes  discharges  from 
mucous  membrane  when  internally  administered,  and  is  a 
useful  external  application  for  relaxed  tissues. 

Therapeutic  Uses. — Myrrh  is  internally  administered  in 
chronic  catarrh,  humoral  asthma,  amenorrhoea,  chlorosis,  leu- 
corrhoea,  chronic  bronchitis,  etc.,  etc. ;  and  in  combination  with 
chalybeates  and  aloes  in  uterine  affections. 

Locally,  myrrh  is  applied  to  inflamed,  ulcerated  and  aphthous 
surfaces. 

Dose — Of  powdered  myrrh,  gr.  x  to  5ss,  in  pill  or  suspended 
in  water. 

TiNXTURE  OF  Myrrh — Tinctura  Myrrhce  {u\yvrh.,%\\])  alco- 
hol, Oij).  Dose. — f5ss  to  foj.  Is  used  internally  and  exter- 
nally. 

Dental  Uses. — Myrrh,  in  the  form  of  the  powder  and  tincture, 
is  employed  as  a  local  application  to  inflamed,  ulcerated  and 
spongy  gums,  ulcerations  of  mucous  membrane  of  the  mouth 
and  throat,  in  the  form  of  a  gargle  ;  also  in  alveolar  pyorrhoea, 
mercurial  stomatitis,  indolent  ulcers,  aphthous  sore  mouth  of 
children.  The  diluted  tincture  forms  a  stimulating  gargle  or 
mouth-wash,  and  the  powder  is  employed  as  an  ingredient  of 
dentifrices,  for  its  stimulating  and  astringent  properties. 


400  DENTAL   MEDICINE. 


Van  ValzaKs  Obtunder  and  Local  AncBsthetic. 

^ .     Pig.  menthol ^  ij 

Tinct.  myrrh ^vj 

Alcohol gx.     M. 

MYRTOL,     RECTIFIED  MYRTLE  OIL. 

Derivation. — Myrtol  is  obtained  from  the  leaves  and  berries 
of  the  Myrtus  Communis  (Myrtacese)  an  evergreen  shrub 
native  of  the  Mediterranean  countries.  It  is  a  volatile  oil  con- 
taining various  terpenes,  cineol,  and  a  camphor-like  substance. 

Medical  Properties  and  Therapeutic  Uses. — Myrtol  is  a  disin- 
fectant and  antiseptic,  and  causes  no  irritation  to  the  skin. 
Upon  a  denuded  or  abraded  surface  it  causes  a  slight  burning 
sensation,  which  soon  passes  off.  It  is  claimed  that  a  9  per 
cent,  solution  of  myrtol  will  completely  arrest  the  growth  of 
the  micro  organisms  of  pus ;  and  myrtol  will  also  prevent  the 
decomposition  of  organic  matters.  Internally  myrtol  promotes 
digestion,  but  large  doses  cause  headache  and  nausea.  It 
communicates  a  violet  odor  to  the  breath  and  urine,  and  is 
eliminated  from  the  system  by  the  lungs  and  kidneys. 

Myrtol  has  been  employed  with  success  as  a  disinfectant  for 
wounds  and  ulcers  ;  also  in  cutaneous  diseases  of  a  vegetable 
parasitic  origin,  and  as  a  local  remedy  in  psoriasis.  Internally, 
myrtol  has  proved  useful  in  the  destruction  of  intestinal 
worms  ;  also  in  chronic  bronchitis,  gangrene  of  lungs,  pulmon- 
ary tuberculosis,  chronic  pyelitis  and  cystitis ;  also  in  passive 
hemorrhage. 

Dose. — gr.  iv. 

Dental  Uses. — Myrtol  is  employed  in  dental  practice  as  a 
disinfectant  of  pulp  canals  and  as  an  antiseptic  for  gangrenous 
pulps,  also  to  destroy  the  growth  of  micro-organisms  in  alveolar 
abscesses,  and  to  disinfect  carious  cavities  in  teeth,  etc,  etc. 


NAPHTHALENE  -NAPHTH  ALIN. 


Formula — CjoHj 


Derivation. — Naphthalene  may  be  obtained  by  subjecting 
coal-tar  to  a  distillation,  when  it  passes  over  the  coal  naphtha. 
It  is  purified  by  subliming  it  with  charcoal,  and  is  then  in  the 


NAPHTHOL.  401 


form  of  a  white,  crystalline  body.  It  has  a  slightly  aromatic 
taste  and  the  odor  of  coal-tar.  While  it  has  no  poisonous 
effect  on  man  and  the  higher  animals,  it  is  destructive  to 
fungi  spores,  small  insects,  etc.  It  is  soluble  in  alcohol,  ether, 
naphtha  and  the  oils,  but  insoluble  in  water.  As  an  expec- 
torant it  has  been  used  in  humoral  asthma  and  in  chronic 
pulmonary  catarrh,  in  doses  of  from  gr.  viii  to  xxx,  in  syrup 
or  emulsions,  and  as  an  ointment  in  skin  diseases  of  a  scaly 
nature ;  also  as  a  vermifuge  in  doses  for  adults  of  gr.  xv. 
followed  immediately  by  2  ounces  of  castor  oil.  Naphthalin  is 
a  powerful  antiseptic,  and  can  be  used  as  a  substitute  for  iodo- 
form, with  the  advantage  of  not  producing  any  constitutional 
action.  Its  application  causes  a  slight  pain  of  short  duration. 
As  an  antiseptic  and  disinfectant  it  is  applied  to  indolent  ulcers, 
septic  and  unhealthy  wounds,  ulcerating  cancerous  growths, 
phagedenic  ulcers,  etc.  It  is  said  that  its  antiseptic  property 
is  superior  to  that  of  carbolic  acid,  and  as  an  odorless  prepara- 
tion, it  will  no  doubt  become  a  desirable  substitute,  as  it  has 
no  corrosive  action  and  will  not  injure  textile  fabrics.  To  deo- 
dorize naphthalin,  simple  mixture  with  benzoic  acid  or  tincture 
of  benzoin  does  not  suffice ;  but  if  mixed  with  benzoin  and 
then  sublimed,  it  loses  its  tarry  odor  and  acquires  a  pleasant 
smell  which  it  retains. 

NAPHTHOL— NAPHTHOL. 

Formula — C,oHyHO. 

Derivation. — Naphthol  is  an  alcohol  derived  from  Naphtha- 
lene (CioHg),  which  is  obtained  from  coal-tar  in  the  form  of 
white  shining  crystals  of  a  strong,  disagreeable  odor,  soluble 
in  alcohol,  but  insoluble  in  water  and  employed  locally  in 
indolent  ulcers  and  a  disinfectant  in  pus-pockets  and  wounds 
and  skin  diseases.     (See  Naphthalene.) 

Medical  Properties  and  Therapeutic  Uses. — There  are  two 
forms  of  Naphthol,  known  as  a  and  b  Naphthol,  the  latter 
being  employed  medicinally  on  account  of  its  less  irritating 
and  injurious  action.  It  is  in  the  form  of  light-brown  crystals, 
soluble  in  hot  water,  and  possessing  antiseptic  properties,  and 
26 


402  DENTAL   MEDICINE. 


employed  internally  and  locally  in  the  form  of  ointment  with 
vaselin  dis'solved  in  alcohol,  ether  or  olive  oil,  in  the  pro- 
portion of  two  per  cent.  It  is  employed  in  parasitic  diseases 
of  the  skin,  and  as  a  general  antiseptic. 

Hydronaphthol. — The  chemistry  of  this  agent,  which  is  sup- 
posed to  be  a  form  of  b  naphthol,  is  not  well  known.  It  is 
in  the  form  of  light  fawn-colored  crystalline  flakes,  having  a 
feeble  odor  and  taste.  As  a  germicide  it  apparently  possesses 
the  power  of  preventing  the  development  of  germs  and  their 
spores.  It  resembles  capsicum  in  possessing  slight  stimu- 
lating and  counter-irritant  properties,  but   is   not  so  powerful. 

Dental  Uses. — Hydronaphthol  is  employed  for  treating  the 
canals  of  pulpless  teeth,  pericemental  inflammation  of  septic 
origin,  especially  in  the  early  stages  before  pus  has  formed. 
Dr.  Jas.  Truman  recommends  a  solution  of  i  :  looo  of  water 
for  injection  into  pulp-canals  ;  and  Dr.  E.  C.  Kirk  recom- 
mends a  paste  of  hydronaphthol  and  glycerine,  pumped  into 
a  thoroughly  cleansed  pulp-canal  in  pericemental  inflamma- 
tion from  septic  causes,  to  remove  the  soreness  and  inflam- 
mation in  a  few  hours :  it  should  be  retained  by  a  temporary 
filling  of  gutta  percha.  It  is  also  recommended  as  an  in- 
gredient for  a  mouth-wash  for  diseased  gums  and  mucous 
membrane. 

Alpha- oxy naphthoic  acid  (or  alpha-naphthol-carbonic  acid)  is 
prepared  in  a  similar  manner  to  salicylic  acid,  naphthol  being 
substituted  for  phenol.  Its  formula  is  QoHg,  COOH.  It  is 
obtained  by  bringing  together  under  strong  pressure,  and  at 
an  elevated  temperature,  alpha-naphthol,  sodium  and  carbonic 
acid  gas.  It  is  nearly  insoluble  in  water,  but  soluble  in  the 
alkalies  and  alkaline  carbonates,  forming  salts,  which  are  color- 
less and  of  neutral  reaction,  and  more  soluble  in  hot  and  cold 
water  than  the  acid  itself.  It  is  antiseptic  and  germicide,  ex- 
periments upon  bacteria  giving  favorable  results. 


NITROUS   OXIDE.  493 

Antiseptic  and  Stimulant  Mouth-  Wash. 

For  use  especially  in  Alveo'ar  Pyorrhoea. 

Dr.  Chas.  B.  Atkinson. 

R  .     Hydronaphthol :?  ij 

Tinct,  Calendulge ^  iv 

Aquae  dest.  q.  s.  ad Aviij.  M 

S. — Use  daily. 

Fragrant  and  Antiseptic  Mouth-  Wash. 
Dr.  a.  W.  Harlan. 

B .     Safrol 360  min 

Oil  of  pinus  pomilia 120  min 

Oil  of  curacoa 120  min 

Oil  of  vetivert 6  drops 

Oil  of  wintergreen 24  drops 

Oil  of  anise,  Saxony 6  drops 

Oil  of  rose  geranium,  Af 6  drops 

Naphthol 60  grs 

Deodorized  alcohol 24  f.  oz 

Solution  of  saccharine ^  i.  oz 

Glycerine 8  f.  oz 

Purified  talcum 2  troy  oz.  M. 

NITROUS  OXIDE— PROTOXIDE  OF  NITROGEN. 
LAUGHING    GAS. 

Formula. — N2O.     Sp.  gr.  compared  with  air  is  about  1.6. 

Derivation. — The  discovery  of  Nitrous  Oxide  Gas  was  made 
by  Dr.  Priestly  in  1776,  and  scientific  investigation  demon- 
strating its  respirability,  by  Sir  Humphrey  Davy,  the  results 
of  which  were  published  some  twenty  years  afterwards.  To 
Dr.  Horace  Wells,  a  dentist  of  Hartford,  Connecticut,  is  due 
the  credit  of  having  demonstrated  its  property  as  an  anaes- 
thetic agent  for  the  relief  of  pain  during  surgical  operations 
in  the  year  1844.  Nitrous  oxide  is  obtained  by  heating  the 
salt  nitrate  of  ammonia  in  a  glass  retort  until  it  melts,  and 
then  boils,  dissolving  into  a  vapor  of  water  and  into  a  perma- 
nent gas. 

The  salt  nitrate  of  ammonia  is  obtained  in  three  forms — the 
crystallized,  the  granulated  and  the  fused.  The  fused  form  is 
prepared  by  melting  the  crystallized  nitrate  of  ammonia,  and 
allowing  it  to  solidify  on  cooling ;  the  granulated  is  prepared 


404  DENTAL   MEDICINE. 


by  evaporating   the  solution  to  a  density  sufficient  to  solidify 
on  cooling,  and  agitating  the  mass  until  it  becomes  cool. 

As  it  is  very  important  to  use  a  pure  form  of  the  nitrate  of 
ammonia  in  the  generation  of  nitrous  oxide  gas,  the  salt, 
either  in  the  fused  or  granulated  state,  may  be  tested  by  heat- 
ing it  on  platinum,  when  the  nitrate,  if  pure,  should  volatilize 
perfectly.  It  may  also  be  tested  by  a  few  drops  of  chloride 
of  barium,  which  should  not  give' a  precipitate  when  added  to 
the  nitrate  of  ammonia ;  should  it  do  so,  then  sulphuric  acid 
is  present;  or,  the  nitrate  of  ammonia  may  be  tested  by  a 
solution  of  nitrate  of  silver,  which  will  also  give  a  precipitate, 
if  chlorine  is  present.  The  test  with  nitrate  of  silver  may  be 
made  by  dissolving  a  drachm  of  the  nitrate  of  ammonia  in 
half  a  glass  of  distilled  water  and  adding  a  few  crystals  of  the 
nitrate  of  silver.  If  the  nitrate  of  ammonia  is  pure,  the  solu- 
tion will  remain  perfectly  clear;  but  should  chlorine  be  pres- 
ent, it  will  show  a  clouded  appearance,  and  should  be  dis- 
carded, as  it  is  not  fit  to  generate  the  gas  from. 

The  salt  nitrate  of  ammonia  is  a  white,  crystalline  sub- 
stance, formed  by  neutralizing  dilute  nitric  acid  by  means  of 
carbonate  of  ammonia,  and  is  so  constituted  as  to  be  resolved 
into  nitrous  oxide  and  water.  A  pound  of  the  salt  will  gen- 
erate about  thirty  gallons  of  the  gas.  In  generating  nitrous 
oxide  gas,  care  must  be  taken  to  preserve  its  purity ;  conse- 
quently it  becomes  important  to  maintain,  as  nearly  as  possi- 
ble, an  equal  temperature  during  its  manufacture;  and  should 
any  7titric  oxide  —  binoxide  of  nitrogen — be  formed,  which 
may  be  done  by  too  high  a  heat  under  the  retort,  it  is  neces- 
sary to  remove  it  and  other  impurities,  by  the  aid  of  solu- 
tions of  caustic  potash  and  copperas ;  the  caustic  potash 
neutralizing  any  free  nitric  acid  present,  and  the  copperas 
removing  either  chlorine  or  nitric  oxide.  The  salt  nitrate  of 
ammonia  is  perfectly  fused  at  226°  F.,  emits  white  fumes  at 
302°  F.,  and  begins  to  evolve  gas  at  460°  F.  At  500°  F. 
the  impurity,  nitric  oxide,  is  given  off;  hence  the  temperature 
during  the  process  should  not  be  permitted  to  rise  above 
482°  F,  which  can  be  determined  by  thermometers  prepared 
for  the  purpose.     No  red  fumes  should  pass  from  the  retort. 


NITROUS  OXIDE.  405 


Liquefied  Nitrous  Oxide. — Nitrous  oxide  gas,  as  principally 
used  at  the  present  time,  is  in  the  form  of  condensed  gas, 
being  liquefied  and  solidified  under  great  pressure,  and  se- 
cured in  iron  cylinders,  from  which  it  escapes  into  an  inha- 
ling bag  when  needed  for  use,  by  turning  a  stop-cock.  Lique- 
fied nitrous  oxide  is  a  colorless  fluid,  having  a  specific  gravity 
of  0.908,  and  at  a  very  low  temperature  (148°  F.)  it  congeals 
into  a  transparent  crystalline  solid.  It  is  prepared  by  con- 
densing the  gas  by  a  pressure  of  fifty  atmospheres  at  a  tem- 
perature of  40°  F.,  and  may  be  kept  in  the  iron  cylinders  for 
an  indefinite  period.  The  advantages  of  the  condensed  form 
of  the  gas  are  its  purity,  convenience  for  use  whenever 
needed,  the  large  supply  which  can  be  kept  for  use,  and  the 
freedom  from  deterioration  notwithstanding  its  age. 

Nitrous  oxide  is  an  elastic,  colorless  gas,  with  a  faint,  but 
agreeable  odor,  and  a  sweetish  taste,  which  it  imparts  to 
water.  Under  a  pressure  of  50  atmospheres  at  about  40°  F. 
it  becomes  a  clear,  colorless  liquid,  and  at  about  148°  F.  be- 
low zero  it  freezes  into  a  beautiful,  clear,  crystalline  solid. 
By  the  evaporation  of  this  solid,  a  degree  of  cold  may  be  pro- 
duced far  below  that  of  carbonic  acid  bath  in  vacuo,  or  lower 
than  170°  F.  The  washing  of  nitrous  oxide  gas,  and  the 
retention  of  it  over  water  for  any  length  of  time,  is  attended 
with  considerable  loss,  as  much  of  it  is  absorbed,  especially 
if  the  water  is  cold;  such  loss  may  be  avoided  to  a  great 
extent  by  using  water  of  an  elevated  temperature  or  a  strong 
solution  of  common  salt.  The  impurities  of  nitrous  oxide 
gas  are  air,  water,  nitric  oxide  or  binoxide  of  nitrogen,  chlo- 
rine and  hyponitric  acid.  The  mixture  with  air,  which  may 
occur  in  the  receiver  or  when  the  patient  is  inhaling  the  gas, 
merely  dilutes  it,  as  does  also  the  vapor  of  water.  Nitric 
oxide,  however,  is  a  dangerous  impurity,  and  with  others 
may  be  generated  even  when  pure  nitrate  of  ammonia  is  used 
in  preparing  the  gas;  this  impurity  is  also  one  of  the  most 
difficult  to  separate  from  the  gas.  Like  nitrous  oxide,  nitric 
oxide  is  a  colorle.ss  gas,  lighter  and  less  soluble  in  water,  and 
if  it  is  generated,  is  liable  to  pass  through  the  washing  solu- 


406  DENTAL   MEDICINE. 


tions  into  the  gasometer  or  receiver;  nitric  oxide,  however, 
need  not  be  generated  if  the  proper  care  is  observed  with 
regard  to  the  degree  of  heat  under  the  retort  which  contains 
the  nitrate  of  ammonia. 

Chlorine  is  also  a  dangerous  impurity,  and  may  be  set  free 
if  the  salt  nitrate  of  ammonia  contains  muriate  of  ammonia 
(sal-ammoniac)  and  chloride  of  ammonium.  To  prevent  such 
contamination,  the  tests  of  the  salt  before  referred  to  may  be 
made.  Nitrous  oxide  gas  supports  combustion  with  almost 
the  same  promptness  as  pure  oxygen ;  and  although  nearly 
identical  in  constitution  with  atmospheric  air,  it  differs  from 
it  both  in  the  proportion  of  its  constitutional  elements  and  in 
the  manner  of  their  association.  Nitrous  oxide  contains 
about  one-third  of  oxygen  to  two-thirds  of  nitrogen,  while 
atmospheric  air  has  only  about  one-fifth  of  oxygen  to  four- 
fifths  of  nitrogen. 

Again,  in  nitrous  oxide,  the  elements  nitrogen  and  oxygen 
are  in  chemical  combination  with  each  other,  while  in  atmos- 
pheric air  there  is  no  apparent  chemical  union  whatever. 

Medical  Properties  and  Action. — Concerning  the  therapeutic 
application  of  nitrous  oxide.  Dr.  L.  Turnbull  says:  "Neuralgia, 
uncomplicated,  will  sometimes  be  relieved  by  a  few  inhala- 
tions of  nitrous  oxide  gas.  Nervous  aphonia,  this  peculiar 
form  of  loss  of  power  over  the  voice,  usually  the  result  of 
hysteria,  will  be  much  improved  by  the  patient  inhaling  suffi- 
cient nitrous  oxide  gas  to  produce  a  partial  loss  of  sensation 
and  muscular  relaxation.  Local  paralysis  has  been  benefited, 
when  there  was  no  brain  lesion,  by  the  gentle  stimulation  by 
the  first  stages  of  the  gas,  or  the  tingling  and  stimulating 
effect  on  the  muscles.  Asthma,  when  of  a  spasmodic  charac- 
ter, is  often  much  improved  by  causing  the  patient  to  pass 
into  the  stage  of  relaxation,  employing  it  every  other  day  for 
a  week  or  two.  It  also  tends  to  expand  the  lungs."  Dr. 
George  J.  Ziegler  found  the  solution  of  the  gas,  in  water,  of 
much  utility  in  diseases  of  the  lungs,  kidneys  and  other  dis- 
eases of  this  class.  Dr.  M.  Price  claims  to  have  employed 
nitrous  oxide  gas  in  many  cases  of  phthisis  with  advantage, 


NITROUS   OXIDE.  407 


and  a  number  of  dentists  have  been  told  by  consumptive  pa- 
tients that  they  have  been  benefited  by  the  inhalation  of  nitrous 
oxide  gas. 

Nitrous  oxide  gas  is  not  only  the  most  pleasant,  but  is 
the  safest  general  ansesthetic  in  use,  and  the  greatest  objec- 
tion to  its  administration  is  the  very  short  anaesthetic  stage 
which  it  induces,  unless  the  inhalation  of  the  gas  be  continued, 
which  is  impossible  in  operations  upon  the  mouth.  When 
inhaled,  the  first  effect  is  dizziness,  with  ringing  noises  in  the 
ears,  a  tingling  sensation,  extending  to  the  extremities,  an 
uplifting  of  the  whole  system,  followed  by  fullness  or  expan- 
sion of  the  chest,  and  a  loss  of  sensation  throughout  the  entire 
body.  According  to  the  temperament,  the  stage  of  excite- 
ment is  transient  or  prolonged ;  in  some  cases  there  are 
strange  illusions,  with  a  form  of  intoxication,  which  may  be 
manifested  by  declamation,  singing,  laughing  or  crying,  or 
melancholy,  with  a  disposition  at  times  to  assault  all  near. 
Such  effects,  if  the  administration  is  interrupted,  soon  pass  off. 
For  surgical  operations,  the  gas  is  given  with  less  admixture 
of  air,  and  the  inhalation  persisted  in  until  the  stage  of  excite- 
ment is  overcome  and  insensibility  produced,  when  the  face 
becomes  extremely  pale,  the  respirations,  at  first  shallow,  be- 
come deep  and  stertorous,  the  jaw  fixed,  the  eyes  protruding, 
and  a  bluish  and  purplish  color  about  the  lips  and  face,  the 
patient  presenting  a  very  alarming  and  death-like  appearance, 
a  condition  of  which  Bartholow  says  :  "So  far  as  the  exterior 
phenomena  can  afford  any  indication  of  the  nature  of  the 
action,  is  an  asphyxiated  state.  The  blood  ceases  to  be  oxy- 
genated, carbonic  acid  accumulates,  and  the  centres  of  con- 
scious impressions  are  rendered  inactive  in  consequence  of  the 
deficient  supply  of  oxygen  and  the  excess  of  carbonic  acid. 
The  rational  indications  of  the  nature  of  the  narcosis  produced 
by  nitrous  oxide  are  confirmed  by  physiological  experiment. 
It  has  been  found  that  the  exhalation  of  carbonic  acid  is  de- 
cidedly diminished  by  the  inhalation  of  nitrous  oxide,  and  that 
animals  live  no  longer  in  an  atmosphere  of  this  gas  than  in  an 
atmosphere  of  hydrogen."     The  same  author  speaks  of  the 


408  DENTAL   MEDICINE. 


fatal  cases  that  have  occurred,  as  being  with  propriety  attribu- 
table to  the  lethal  action  of  this  gas,  and  refers  to  various 
cases  under  his  own  observation  in  which  nervousness,  vague 
mental  symptoms  and  headache  have  been  experienced  after 
the  inhalations;  at  the  same  time  he  pronounces  nitrous  oxide 
to  be  almost  free  from  danger.  There  is  no  doubt  but  that  the 
prompt  action  of  nitrous  oxide  gas,  and  the  rapid  subsidence 
of  the  narcosis,  have  much  to  do  with  its  safety,  and  account 
for  the  impunity  with  which  it  is  used.  Nitrous  oxide  gas  has 
the  advantages  of  safety;  also  rapid  anaesthesia,  which  is  gen- 
erally induced  in  from  thirty  seconds  to  a  minute  and  a  half, 
insensibility  often  occurring  before  complete  unconsciousness; 
also  the  pleasant  odor  and  taste,  thereby  preventing  repug- 
nance and  nausea ;  and  the  complete  recovery  from  its  influ- 
ence without  unpleasant  after-effects.  It  generally  requires  six 
gallons  or  less  to  produce  anaesthesia  with  nitrous  oxide  gas ; 
hence  the  rubber  bag  from  which  it  is  inhaled  should  have  a 
capacity  of  about  eight  gallons. 

Mode  of  Administration. — The  most  improved  apparatus 
consists  of  an  iron  cylinder  containing  lOO  gallons  or  more 
of  the  condensed  or  liquefied  nitrous  oxide,  to  which  is  at- 
tached a  rubber  gas  bag  and  inhaling  tube  with  a  double  valve 
and  mouth-piece.  The  patient,  for  dental  operations,  is  seated 
in  a  suitable  chair  which  will  admit  of  the  back  being  lowered 
to  such  a  degree  as  will  bring  the  patient  to  an  almost  hori- 
zontal posture,  and  the  head  well  supported.  A  piece  of  India 
rubber  or  a  firm  cork  to  which  a  thin,  strong  cord  is  attached, 
to  prevent  its  slipping  down  the  throat,  is  placed  between  the 
teeth,  so  as  to  prevent  the  closure  of  the  jaws,  for,  unlike  chlor- 
oform and  ether,  the  muscles  become  rigidly  contracted  under 
the  influence  of  this  gas;  such  a  prop  also  prevents  injury  to 
the  front  teeth  by  the  patient  biting  too  hard  on  the  mouth- 
piece of  the  inhaling  tube.  The  patient  is  then  directed  to 
breathe  deeply  and  regularly,  the  nose  being  held,  to  prevent 
the  admixture  of  atmospheric  air,  and  the  same  precautions 
observed  as  are  necessary  when  administering  ether  or  chloro- 
form.   (See  Ether.)  The  anaesthetic  state,  or  "  surgical  period," 


NITROUS   OXIDE.  409 


as  it  is  termed,  is  generally  manifested  by  snoring,  although 
this  symptom  does  not  invariably  occur ;  when  it  does,  how- 
ever, it  indicates  a  state  of  profound  anaesthesia,  to  which  it  is 
necessary  to  carry  the  patient  when  performing  many  minor 
surgical  operations. 

As  more  or  less  excitement  follows  the  inhalation  of  this 
gas,  when  it  is  largely  mixed  with  atmospheric  air,  such  a 
condition  is  either  prevented  or  abbreviated  by  holding  the 
nose  of  the  patient  during  the  inhalation.  The  patient  should 
not  partake  of  food  for  at  least  two  hours  before  the  adminis- 
tration of  the  gas,  but  at  the  same  time  should  not  be  in  a 
weakened  condition  for  want  of  it;  and  the  dress,  if  tight, 
should  be  previously  loosened,  and  as  soon  as  the  operation 
is  completed  the  head  should  be  gently  moved  to  one  side, 
to  allow  the  blood  to  escape  from  the  mouth.  Fresh  air 
should  then  be  admitted  into  the  room,  and  the  patient  sup- 
plied with  it  by  means  of  a  fan.  (See  Administration  of 
Anaesthetics.) 

Therapeutic  and  Dental  Uses. — According  to  the  investiga- 
tions of  Dr.  Ziegler,  nitrous  oxide  is  an  efficient  restorative 
when  administered  either  in  its  gaseous  state  by  the  lungs,  or 
in  conjunction  with  liquids  by  the  alimentary  canal.  He 
recommends  the  use  of  this  gas  in  moderate  quantities,  so  as 
not  to  generate  too  much  carbonic  acid.  Regarding  nitrous 
oxide  and  oxygen  as  of  primary  importance  in  asphyxia,  and 
the  natural  antidotes  to  narcotizing  agents  and  asphyxiated 
conditions,  he  advocates  their  use  whenever  practicable,  either 
alone  or  in  combination  with  heat,  and  claims  that  they  will 
often  save  life  in  apparently  hopeless  cases. 

The  rapid  action  of  nitrous  oxide  and  the  transient  nature 
of  its  effects  on  the  system,  render  it  a  very  useful  anaesthetic 
agent  for  all  minor  surgical  operations — such  as  extracting 
teeth,  lancing  abscesses,  devitalizing  nerves  of  teeth,  etc,  etc. 
It  has  also  been  successfully  employed  in  the  performance  of 
some  capital  surgical  operations,  where  the  anaesthesia  has 
been  kept  up  from  fifteen  minutes  to  half  an  hour.  It  has 
recently  been  recommended  to  use,  during  the  first  part  of  an 


410  DENTAL   MEDICINE. 


inhalation,  the  pure  nitrous  oxide  gas,  and  for  the  purpose  of 
prolonging-the  anaesthesia  with  less  danger,  to  dispense  with 
the  pure  gas  and  administer  a  mixture  of  oxygen  and  nitrous 
oxide  in  proportions  very  similar  to  the  air  we  breathe. 

NUX  VOMICA. 

Source. — The  seed  of  the  Strychnos  nux  vomica,  which  con- 
tains two  alkaloids,  strychnine  and  brncine,  the  amount  of 
strychnine  being  one-fourth  to  one-half  per  cent,  and  of  bru- 
cine  from  one-eighth  to  one  per  cent. 

Strychnine — Strychnina  (CsiHgaNjOg) — is  a  white  or  gray- 
ish white  powder  of  a  very  bitter  taste,  almost  insoluble  in 
water,  and  very  soluble  in  boiling  alcohol. 

Sulphate  of  Strychnine — Strychnijice  Sulphas — is  a  white 
salt  in  the  form  of  colorless  prismatic  crystals,  which  are  very 
bitter  and  odorless,  soluble  in  ten  parts  of  water,  somewhat  so 
in  alcohol,  but  insoluble  in  ether. 

Medical  Properties  and  Therapeutic  Uses. — Nux  vomica 
and  strychnine  are  bitter  stomachic  and  muscular  tonics.  In 
small  doses  strychnine  increases  the  gastro-intestinal  secre- 
tions, hastens  intestinal  movements,  and  elevates  arterial  ten- 
sion. In  larger  doses  the  pupils  are  dilated  and  the  muscles 
spasmodically  contracted.  Poisonous  doses  cause  muscular 
tremors,  intermittent  tetanic  spasms,  and  death  from  rigidity 
of  the  respiratory  muscles,  without  any  inpairment  of  the 
mind. 

Poisonous  quantities  of  strychnine  accumulate  in  the  sys- 
tem, on  account  of  the  agent  being  slowly  excreted,  from  very 
small  doses  frequently  administered.  The  antidotes  are  free 
evacuation  of  the  stomach,  vegetable  astringents  to  precipi- 
tate the  strychnine,  and  the  inhalation  of  ether  or  chloroform, 
and  the  hypodermic  injection  of  chloral.  Strychnine  is  em- 
ployed in  anaemia,  atonic  dyspepsia,  constipation,  vomiting  of 
pregnancy,  gastralgia,  gastric  catarrh,  etc.,  of  drunkards, 
chlorosis,  purpura,  hemorrhagic  diathesis,  local  paralysis,  poi- 
soning by  lead,  spasmodic  asthma,  etc.,  etc.  It  is  an  antidote 
to  chloral,  and  nux  vomica  is  used  in  intermittent  fever  as  an 


OLEATES.  4X1 

adjunct  to  quinine.  Brucine  is  much  weaker  than  strychnine 
but  similar  in  its  action,  and  the  pure  agent  is  analogous  to 
cocaine,  possessing  local  anaesthetic  properties.  For  hypo- 
dermic injection  it  is  resorted  to  in  paraplegia,  infantile  paraly- 
sis, facial  paralysis,  etc.,  and  also  in  diseases  of  the  eye,  and 
infraorbital  paralysis.  A  half-grain  of  strychnine  has  pro- 
duced a  fatal  result,  and  one-twelfth  of  a  grain  will  produce 
muscular  twitchings,  and  one-sixteenth  of  a  grain  has  proved 
fatal  in  the  case  of  a  child. 

Dose. — Of  Abstractum  nucis  vomicae,  gr.  \ ;  of  Extractum 
nucis  vojfiicae,  gr.  \  to  gr.  \ ;  of  Extractum  ?mcis  vomicce  flu- 
idum,  TTL  j  to  v ;  of  Tinctura  nucis  vomicce,  1llv  to  x ;  of 
Stryclmi?ia,  gr.  eV  ^o  2V  5  o^  Strychnince  Sulphas,  gr.  -^^  to  -^  \ 
of  Brucine,  gr.  yg  to  \. 

DENTAL    FORMULA. 
For  Neuralgia. 

R .         Ext.  nucis  vom gr-  v 

Zinci  valerian J^ij 

Ext.  gentiante '    '    '    •    •  BJ-  M. 

Fiat  pill  No.  XX. 

SiGNA. — One  pill  three  or  four  times  a  day. 

OLEATES. 

Medicinal  oleates  are,  according  to  Dr.  J.  D.  Shoemaker, 
definite  chemical  compounds  or  salts,  having  no  excess  of 
either  their  acid  or  basic  radicals,  and  Dr.  Lawrence  Wolff 
finds  that  the  best  and  readiest  method  of  preparing  oleates  is 
by  the  double  decomposition  of  sodium  oleates  with  solutions 
of  neutral  salts.  The  sodium  oleate  is  made  by  the  saponifi- 
cation of  oleic  acid  with  sodium  hydrate.  Dr.  Squibb,  how- 
ever, is  of  the  opinion  that  in  the  preparation  of  oleates,  none 
are  so  good  as  those  made  by  the  direct  union  of  the  acid  with 
the  dry  base,  without  heating,  and  that  the  preparation  should 
always  be  either  a  liquid  or  semi-solid  which  is  easily  and 
completely  liquefied  by  the  natural  temperature  of  the  surface 
to  which  it  is  applied  ;  and  he  further  says  that  in  the  rare 
cases  where  the  excess  of  acid  as  a  solvent  of  the  oleates 
proves  an  irritant  to  the  skin,  dilution  with  a  bland  oil  becomes 


412  DENTAL   MEDICINE. 


admissible.  The  most  common  oleates  in  use  are  those  of 
mercury,  zinc,  lead,  copper,  aluminium,  bismuth,  iron,  arsenic, 
silver,  aconite,  atropine,  morphine,  veratria  and  strychnine. 
Oleates  of  the  more  active  alkaloids,  namely,  aconitia,  atropia, 
strychnia  and  veratria,  are  usually  made  of  the  strength  of  two 
per  cent,  of  the  alkaloid ;  the  oleate  of  morphia  usually  con- 
tains five  per  cent,  of  the  alkaloid ;  the  oleate  of  quinine 
usually  contains  twenty  per  cent,  of  the  alkaloid.  Dr.  Squibb 
says  that  all  of  these  are  very  simply  and  easily  made  by  put- 
ting the  weighed  quantity  of  the  alkaloid  into  a  mortar,  adding 
a  small  quantity  of  the  oleic  acid,  little  by  little,  and  triturating 
until  the  alkaloid  is  completely  dissolved.  The  strong  solu- 
tion thus  made  is  then  poured  into  a  tarred  bottle,  and  the 
mortar  and  pestle  rinsed  twice  into  the  bottle  with  small  quan- 
tities of  oleic  acid.  The  proper  weight  is  then  made  up  by 
the  addition  of  oleic  acid. 

According  to  the  preparation  of  oleates  as  recommended  by 
Dr.  Shoemaker — 

Oleate  of  Mercury  is  prepared  by  precipitating  a  solution  of 
sodium  oleate  with  mercuric  chloride,  and  is  the  best  local 
stimulant  and  alterative  application  of  all  the  mercurials.  It 
may  be  diluted  with  either  the  paraffinates,  or,  better  still,  with 
lard  or  lard  oils.  When  applied  to  the  unbroken  skin  it  causes 
marked  stimulation,  bordering  on  congestion.  It  has  great 
penetrating  power,  is  readily  absorbed  by  the  skin,  and  does 
not  become  rancid  nor  stain  the  linen.  It  is  a  valuable  remedy 
in  syphilis,  the  treatment  of  indurations  after  abscesses,  skin 
diseases  of  a  scaly  nature,  obstinate  ulcers,  parasitic  affections, 
etc.,  and  may  be  employed  advantageously  with  other  oleates. 
As  it  is  capable  of  producing  the  constitutional  effects,  it  must 
be  employed  carefully. 

A  mixture  of  oleate  of  mercury  gr.  x  to  xx,  with  the  oint- 
ment of  oleate  of  zinc  5j,  is  very  effective  in  chronic  acne  and 
eczema,  especially  in  the  fissured  variety  of  the  latter  common 
to  the  palmar  and  plantar  surfaces.  For  syphilitic  skin  erup- 
tions and  in  superficial  ulcers,  oleate  of  mercury  5j,  with 
oleate  of  bismuth  5iij,  or  the  same  quantity  of   the  ointment 


OLEATES.  413 

of  the  oleate  of  lead,  acts  promptly  and  efficiently.  For  one 
of  the  best  and  most  efficacious  oily  applications  for  loss  of 
hair,  especially  when  the  scalp  is  harsh  and  dry,  and  the 
hairs  dull  and  without  lustre,  a  preparation  composed  of 
oleate  of  mercury  3j  to  ij,  with  oil  of  ergot  oj,  is  highly 
recommended. 

Oleate  of  Zinc  is  prepared  by  decomposing  a  sodium  oleate 
with  a  saturated  solution  of  zinc  sulphate,  boiling  out  and 
drying  the  precipitate  and  then  reducing  it  to  an  impalpable 
powder.  One  part  of  oleate  of  zinc  melted  with  three  parts 
of  lard  or  oil  gives  a  most  useful  ointment,  but  the  best  results 
are  obtained  from  the  oleate  of  zinc  alone.  It  is  in  the  form 
of  a  fine,  pearl-colored  powder,  having  a  soft,  soapy  feel,  much 
like  powdered  French  chalk.  It  is  valuable  in  all  forms  of 
sweating. 

Oleate  of  Lead  is  prepared  by  precipitating  a  sodium  oleate 
with  a  solution  of  lead  subacetate.  To  form  the  ointment  of 
lead  oleate,  the  washed  and  dried  precipitate  is  melted  with 
equal  parts  of  lard.  Oleate  of  lead  exerts  a  combined  seda- 
tive and  astringent  action  when  applied  to  denuded  skin,  and 
also  arrests  morbid  discharges,  protects  the  surface,  and  allays 
irritation.  It  is  useful  in  eczema,  acne  and  other  skin  diseases. 
For  skin  diseases,  oleate  of  lead  5ij,  with  oleate  of  bismuth 
oj,  is  very  effectual,  especially  in  the  fissured  form  of  palmar 
and  plantar  eczema ;  and  when  the  cracking  is  very  deep,  to 
cause  stimulation,  oil  of  cade  gtt.  xx  to  xxx  may  be  added. 
In  scabies,  oleate  of  lead  5iv  with  sulphur  5ss  is  an  excellent 
application. 

Oleate  of  Aluminum  is  prepared  by  decomposing  sodium 
oleate  with  aluminum  sulphate.  The  washed  precipitate, 
mixed  with  equal  parts  of  lard,  forms  an  ointment  of  a  semi- 
solid, dark-brown  color,  which  is  very  astringent  in  its  action. 
It  rapidly  arrests  all  muco-purulent  discharges,  and  is  an 
efficient  dressing  for  foul  ulcers,  sinuses,  burns  and  scabs. 

Oleate  of  Bismuth  is  prepared  by  first  obtaining  crystallized 
bismuth  nitrate,  and  dissolving  it  in  glycerine  and  decomposing 
with  this  the  sodium  oleate.     It  is  of  the  consistence  of  oint- 


414  DENTAL   MEDICINE. 


ment,  and  of  a  pearly-gray  color  and  a  soft,  bland  substance. 
It  has  an  emollient  and  somewhat  astringent  action,  and  is  an 
excellent  application  for  relieving  cutaneous  irritation.  In 
pustular  eruptions,  especially  sycosis,  it  is  a  useful  application  ; 
also  in  superficial  erysipelas,  sunburn  and  chronic  inflamma- 
tion of  a  portion  of  the  face. 

Oleate  of  Copper  is  prepared  in  a  similar  way  to  the  oleate 
of  lead,  by  double  decomposition  with  a  saturated  solution  of 
copper  sulphate.  A  ten  or  twenty  per  cent,  ointment  can  be 
made  with  either  cosmoline,  fat  or  lard.  When  applied  to  the 
unbroken  skin,  it  penetrates  deeply,  and  causes  a  slight  stim- 
ulation ;  and  when  applied  to  broken  skin,  it  coats  it  with  an 
insoluble  albuminate.  It  is  very  efficient  for  ringworm,  and 
in  the  most  obstinate  cases  usually  effects  a  cure.  It  is  also 
used  with  advantage  on  indolent  ulcerated  surfaces,  and  with 
effect  on  hard,  horny  warts  and  corns. 

Oleate  of  Arseitic  is  obtained  from  arsenious  chloride,  made 
by  the  careful  saturation  of  hydrochloric  acid  with  arsenic. 
This  solution  is  mixed  with  sodium  oleate,  when  the  arsenic 
oleate  is  precipitated.  In  the  proportion  of  gr.  xx  to  an  ounce 
of  fatty  base,  it  forms  oleate  of  arsenic  ointment,  which  is  soft 
and  yellow,  having  no  action  on  the  skin.  When  applied  to 
wounds,  or  ulcerating  surfaces,  it  destroys  the  tissue  to  some 
depth.  It  is  used  in  lupus,  the  ulcerating  variety  of  epithe- 
lioma, and,  after  scraping  the  surface,  to  destroy  warts,  corns, 
old  granulations,  etc.  It  may  be  combined  with  arnica,  opium, 
belladonna  or  hyoscyamus. 

A  number  of  other  oleates  are  in  use,  among  them  Nickel 
oleate,  which  is  a  greenish,  waxy  mass,  which  is  used  in  the 
form  of  an  ointment,  containing  from  five  to  fifteen  grains  to 
the  ounce  of  lard,  is  astringent  and  somewhat  escharotic,  and 
useful  for  hard,  horny,  granulating  surfaces;  Silver  oleate,  a 
brownish  pulverent  substance,  and,  in  the  form  of  ointment, 
valuable  for  application  to  ulcers,  erysipelas,  etc. ;  Cadjnium 
oleate,  a  yellowish-white  mass,  and  in  the  form  of  ointment 
(five  to  fifteen  grains  to  the  ounce),  has  an  astringent  and 
escharotic  action,  and  is  useful  in  glandular  enlargements  and 
thickening  of  the  integument. 


OIL   OF   CAJUPUT.  415 


OLEUM  AMYGDALAE  DULCIS— OIL  OF  SWEET  ALMONDS. 

Derivation. — The  Oil  of  Sweet  Almonds  is  obtained  by  first 
depriving  the  almonds  of  the  brown  powder  adhering  to  their 
surface,  and  rubbing  them  together  in  a  piece  of  coarse  linen, 
then  grinding  in  a  mill  or  mortar,  and  then  submitting  them 
to  pressure  in  canvas  sacks  between  slightly  heated  plates  of 
iron.  The  oil,  which  is  at  first  turbid,  is  clarified  by  rest  and 
filtration.  It  is  clear,  colorless,  or  of  a  slight  greenish-yellow 
tinge,  nearly  inodorous,  with  a  bland,  sweetish  taste.  It  will 
remain  liquid  at  temperatures  below  the  freezing  point  of  water. 

Medical  Properties  afid  Actioji. — The  oil  of  sweet  almonds 
is  demulcent. 

Therapeutic  Uses. — -It  is  employed  as  an  emulsion  m  pul- 
monary affections  with  cough,  and  as  a  vehicle  for  other  medi- 
cines. 

Dental  Uses. — The  oil  of  sweet  almonds  forms  a  pleasant 
and  soothing  application  for  excoriations  of  the  lips  and  in- 
flamed mucous  membranes ;  also  for  a  soothing  application  to 
the  small,  simple,  but  painful  ulcers  which  sometimes  appear 
upon  the  gums,  mucous  membrane  of  the  cheeks,  and  the 
tongue.  Almond  mixture — Mistiira  Amygdala — is  made  by 
dissolving  a  mixture  of  half  an  ounce  of  blanched  sweet  al- 
monds, 30  grains  of  gum  Arabic  and  120  grains  of  sugar,  in 
half  a  pint  of  distilled  water.     It  forms  a  pleasant  demulcent. 

OLEUM  CAJUPUTI-OIL  OF  CAJUPUT. 

Source. — The  volatile  oil  of  the  leaves  of  melaleuca  caju- 
puti,  a  tree  indigenous  in  Batavia  and  Singapore.  It  is  trans- 
parent, of  a  green  color,  with  an  odor  like  camphor,  and  a 
warm,  pungent  taste. 

Medical  Properties  and  Action. — Cajuput  Oil  is  a  diffusible 
stimulant,  antispasmodic  and  diaphoretic.  Internally  adminis- 
tered it  causes  a  sensation  of  warmth  in  the  stomach,  and  ex- 
cites the  action  of  the  heart  and  arteries,  afterward  producing 
copious  diaphoresis.  Externally,  either  alone  or  in  combina- 
tion with  equal  parts  of  soap  liniment  or  olive  oil,  it  is  an  ef- 


416  DENTAL   MEDICINE. 


ficient  rubefacient  and  stimulant  embrocation.  Its  use  is  be- 
coming more  common. 

Therapeutic  Uses. — It  is  employed  internally  as  an  anti- 
spasmodic stimulant  in  typhus  and  other  low  fevers,  spasmodic 
cholera,  gout  and  rheumatism,  neuralgic  affections,  hysteria, 
flatulence  and  flatulent  colic,  headache,  nausea,  etc.  Exter- 
nally, in  neuralgia,  headache,  gout,  rheumatism,  lumbago, 
sprains,  contusions,  paralysis,  etc.,  etc. 

Dose. — Of  cajuput  oil,  gtt.  j  to  gtt.  v,  in  emulsion,  or  on 
sugar. 

Dental  Uses. — Cajuput  oil  is  an  efficacious  remedy  for  the 
relief  of  odontalgia,  applied  on  lint  or  cotton  to  the  carious 
cavity  of  the  tooth  ;  also  in  neuralgic  affections,  if  they  are  not 
connected  with  inflammatory  action. 

OLEUM  CARYOPHYLLI— OIL  OF  CLOVES. 

Source. — Oil  of  Cloves  is  obtained  from  the  dried  flower 
buds  of  the  caryophyllus  aromaticus,  an  evergreen  tree,  of  the 
natural  order  Myrtacea — myrtle  order — a  native  of  the  Indies. 
The  unexpanded  buds  are  of  a  dark-brown  color,  with  a  yel- 
lowish red  tint. 

The  oil  is  prepared  by  distilling  cloves  with  water,  to  which 
common  salt  is  added,  in  order  to  raise  the  temperature  to  the 
boiling  point.     It  has  a  fragrant  odor,  and  a  hot,  acrid  taste. 

Medical  Properties  and  Action. — Oil  of  cloves  contains  tan- 
nic acid,  a  pungent,  volatile  oil,  resin,  etc.,  and  two  substances 
— a  hydro- carbon,  caryophyllin,  and  an  oxygenated  oil,  eugeitol, 
called  an  acid  on  account  of  its  possessing  acid  properties. 
Oil  of  cloves  is  an  aromatic  and  powerful  stimulant.  Although 
it  is  a  very  fluid,  clear  and  colorless  preparation  when  fresh, 
it  becomes  yellow  by  exposure,  and  ultimately  reddish  brown, 
with  the  odor  of  cloves,  and  a  hot,  aromatic  taste.  Like 
cloves,  the  oil  acts  less  upon  the  system  at  large  than  on  the 
part  to  which  it  is  immediately  applied. 

Therapeutic  Uses. — Oil  of  cloves  is  sometimes  administered 
to  relieve  nausea  and  vomiting,  to  correct  flatulence  and  excite 


OIL  OF   CLOVES.  417 


digestion  when  languid;  but  its  chief  use  is  to  modify  the 
action  of  other  medicines. 

Dose. — Of  oil  of  cloves,  gtt.  ij  to  gtt.  vj. 

Dental  Uses. — In  dental  practice,  oil  of  cloves  is  employed 
to  relieve  odontalgia,  either  alone,  as  in  the  form  of  a  drop  or 
two  upon  cotton,  introduced  into  the  carious  cavity  of  a  tooth, 
and  obtunds  the  pain  by  an  over-stimulating  effect  upon  the 
irritable  pulp.  It  is  also  employed  for  the  same  purpose  in 
combination  with  other  agents,  such  as  morphia,  sweet  spirits 
of  nitre,  etc.  When  the  use  of  creasote  or  carbolic  acid  is 
prohibited,  owing  to  the  patient's  idiosyncrasy,  the  oil  of 
cloves  may  be  substituted. 

The  oil  of  cloves  has  also  the  effect  of  rendering  creasote 
and  carbolic  acid  more  pleasant,  without  interfering  with  their 
action,  being  added  in  equal  admixture.  It  is  also  employed 
in  the  treatment  of  alveolar  abscess,  putrid  pulps  being  applied 
like  creasote  or  carbolic  acid,  or  combined  with  other  agents 

Eiigenol^  C10H12O2,  also  called  eugenic  acid,  is  an  active  prin- 
ciple of  oil  of  cloves,  and  is  prepared  by  decomposing  eugenate 
of  potassium  with  sulphuric  acid.  It  is  in  the  form  of  a  color- 
less oil,  of  the  specific  gravity  of  1.076.  Its  odor  resembles 
that  of  oil  of  cloves,  and  it  has  a  sharp,  penetrating  taste.  It 
does  not  decompose  at  ordinary  temperatures,  and  is  not 
affected  by  exposure  to  the  air.  It  is  soluble  in  water  and 
alcohol,  but  the  aqueous  solution  is  the  more  potent  as  a 
germicide.  It  is  not  poisonous,  and  when  pure  will  coagulate 
albumen.  For  dental  uses  eugenol  is  of  considerable  value. 
When  applied  to  exposed  or  partially  exposed  pulps  of  teeth 
it  usually  relieves  the  pain  in  from  one  to  two  minutes.  For 
inflamed  and  congested  pulps,  it  has  been  suggested  to  first 
apply  a  solution  of  borax  and  then  eugenol.  It  also  answers 
well  as  a  dressing  for  root  canals,  especially  after  the  removal 
of  a  recently  devitalized  pulp.  In  alveolar  pyorrhoea,  it  is  used 
in  solution,  i  part  of  eugenol  to  1000  of  water,  for  the  purpose 
of  cleansing  the  pus  pockets.  In  alveolar  abscesses  it  has 
been  suggested  as  an  injection,  after  the  use  of  peroxide  of 
hydrogen,  taking  the  precaution,  in  cases  of  abscesses  with  a 
27 


418  DENTAL   MEDICINE. 


fistulous  tract,  to  seal  the  root  at  the  apex.  It  has  also  been 
successfully  employed  in  the  treatment  of  benign  tumors  of 
the  mouth,  in  the  form  of  an  injection  of  two  drops. 

OLEUM  MORRHU^E— COD-LIVER   OIL. 

Source. — Cod-liver  oil  is  obtained  from  the  liver  of  the  cod, 
Gadus  morrhu(B,  and  is  in  the  form  of  a  fixed  oil,  containing 
biliary  principles,  traces  of  iodine,  bromine,  phosphorus,  lime, 
magnesia,  iron,  soda  and  sulphuric  and  phosphoric  acids;  also 
a  principle  known  as  gaduin.  By  distillation  with  ammonia,  it 
yields  propylaviin.  The  pale  oil  is  considered  to  be  the  best 
for  internal  use,  and  is  the  official  preparation.  Iodine,  phos- 
phorus, bromine  and  iron  are  often  combined  with  cod-liver  oil, 
but  are  considered  to  add  nothing  to  its  therapeutical  powers. 
The  special  medicinal  value  of  this  oil  depends  upon  the 
gaduin  and  propylamin,  which  are  constituents  of  bile,  iodine, 
phosphorus,  bromine,  etc.,  as  well  as  upon  the  common  ingre- 
dients of  animal  fat.  The  phosphates,  hypo-phosphites,  or  the 
lacto-phosphate  of  lime  are  often  combined  with  cod-liver  oil, 
with  excellent  effects. 

Medical  Properties  and  Therapeutic  Uses. — Cod-liver  oil  is 
considered  to  be  a  valuable  remedy  in  certain  forms  of  phthisis, 
such  as  the  chronic  forms, — chronic  tuberculosis  and  fibroid 
lung;  but  not  in  acute  phthisis  and  caseous  pneumonia;  also 
in  chronic  affections  of  the  brain  and  nervous  system,  and 
such  skin  diseases  as  lupus,  ecthyma,  psoriasis,  etc.  It  is  also 
employed  in  sequelse  of  scarlet  fever,  chronic  bronchitis,  em- 
physema, chronic  rheumatism  and  rheumatic  arthritis,  strumous 
synovitis,  scrofula,  caries  and  necrosis  of  bone,  scrofulous, 
rickety  infants  and  chlorotic  girls  derive  benefit  from  warm 
baths  and  inunctions  of  the  oil ;  also  lean  persons.  Inunc- 
tion with  cod-liver  oil  is  also  useful  in  rubeola,  scarlatina,  ery- 
sipelas, high  fevers,  catarrhal  attacks,  scrofula,  phthisis,  chronic 
dysentery,  etc.  It  builds  up  the  tissues,  repairs  waste  and 
supplies  nervous,  muscular  and  digestive  power.  It  may  be 
administered  in  ale,  beer,  coffee,  lemon  juice,  hot  whiskey 
punch,  compound  spirits  of  lavender  and  brandy,  or  washing 


OPIUM.  419 

out  the  mouth  with  whiskey  or  brandy,  or  as  an  emulsion 
made  with  glycerine  and  yolks  of  eggs,  and  flavored.  It  is 
also  used  in  the  preparation  of  bread  in  form  of  rolls;  ether 
added  to  it  promotes  its  digestion ;  fifteen  minims  of  ether  to 
every  half-ounce  of  the  oil. 

Dose. — Of  cod-liver  oil,  foj  to  5iv, 

OPIUM. 

Source. — Opium  is  obtained  from  the  unripe  capsules  of  the 
papaver  somniferum,  of  the  natural  order  Papaveraccce — poppy- 
order,  in  the  form  of  a  concrete  juice,  which  exudes  from  in- 
cisions, and  which  is  permitted  to  evaporate  spontaneously. 
Commercial  opium  is  in  the  form  of  irregular  masses,  of  from 
a  few  ounces  to  several  pounds  in  weight,  with  a  moist,  brown 
or  chestnut  surface,  and  a  peculiar  odor  and  nauseous  taste. 
The  purest  form  should  have  a  chestnut  color,  a  strong  aro- 
matic flavor,  and  a  dense  consistence,  and  break  with  a  deeply 
notched  fracture,  and  w^ien  drawn  across  white  paper  leave  an 
uninterrupted  line. .  The  alkaloid  morphine  is  the  most  impor- 
tant of  the  chemical  constituents  of  opium.     (See  Morphine.) 

Medical  Properties  ajid  Uses. — As  an  anodyne  and  hypnotic 
opium  possesses  the  power  of  relieving  pain  and  inducing 
sleep ;  it  relaxes  muscular  spasm,  and  hence  is  a  very  efficient 
remedy  in  tetanus,  spasms,  nervous  irritability  and  discharges 
of  a  morbid  nature.  It  excites  the  circulation  as  a  first  action, 
and  increases  the  temperature  of  the  skin,  and  causes  an  agree- 
able exhilaration  of  the  intellectual  faculties,  so  much  so  as  to 
be  used  by  some  as  an  habitual  narcotic,  which  is  finally  de- 
structive to  both  the  physical  and  mental  functions.  But  the 
stage  of  excitement  is  very  transient,  and  is  succeeded  by  a 
falling  of  the  pulse,  a  diminished  susceptibility  to  external 
impressions,  confusion  of  mind  and  the  loss  of  consciousness 
in  deep  sleep.  Other  effects  are  also  manifested,  such  as  dry- 
ness of  the  throat,  thirst,  and,  in  some  cases,  nausea  and  vomit- 
ing, with  an  itching  miliary  eruption  on  the  skin. 

Taken  in  large  or  poisonous  dcses,  opium  does  not  cause 
any  excitement,  but  giddiness  and  .stupor  rapidly  supervene, 


420  DENTAL   MEDICINE. 


with  a  lessening  in  the  frequency  of  the  pulse,  but  not  in 
fullness,  a  tendency  to  sleep,  which  is  irresistible,  and  finally 
coma,  in  which  the  breathing  is  heavy  and  stertorous,  the 
pulse  slow,  and  the  pupils  contracted,  with  a  sinking  of  the 
pulse  and  relaxation  of  the  muscles  immediately  preceding 
death ;  in  the  case  of  children  death  is  often  preceded  by  vio- 
lent convulsions. 

The  antidotes  in  poisoning  by  opium  are  the  stomach  pump, 
emetics  in  double  doses,  such  as  sulphate  of  zinc,  in  doses  of 
gr.  XX  to  gr.  XXX,  or  sulphate  of  copper,  gr.  v  to  gr.  x ;  also 
mustard  in  powder,  5ss,  or  powdered  alum,  answer  as  emetics, 
strong  coffee,  keeping  the  patient  in  motion,  counter-irritation 
to  nape  of  neck,  flagellation  to  the  palms  of  the  hands  and 
soles  of  the  feet,  and  the  electro- magnetic  battery,  which  is 
often  efficient  when  other  measures  fail,  artificial  respiration, 
and  belladonna,  in  hypodermic  injections  of  its  alkaloid  atro- 
pine, in  solution.     No  local  lesions  are  found  after  death. 

Therapeutic  Uses. — Opium  as  an  anodyne  and  hypnotic  is 
employed  in  almost  all  diseases  where  the  necessity  of  assuag- 
ing pain  and  inducing  sleep  is  required.  (See  Morphine.) 
Opium  is  contra-indicated  where  there  is  a  tendency  to  apo- 
plexy or  coma,  or  where  an  unusual  susceptibility  to  its  in- 
fluence exists,  and  it  should  be  administered  to  the  very  young 
and  very  old  with  great  caution.  When  long  administered  it  is 
necessary  to  increase  the  dose.  Externally,  in  the  form  of 
powder,  it  is  applied  to  irritable  ulcers,  etc.,  and  to  the  rectum, 
as  suppositories. 

Dose. — Of  opium,  in  powder  or  pill,  as  an  anodyne  and 
hypnotic,  gr.  j. 

Dental  Uses. — Opium  is  employed  as  an  anodyne  in  con- 
vulsions of  teething,  but  must  be  administered  with  great  care 
and  in  small  doses ;  also  as  an  anodyne  preparatory  to  lancing 
the  gums  of  children ;  also  in  mercurial  salivation,  to  arrest 
the  excessive  secretion,  in  doses  of  gr.  j  every  four  hours ; 
also  in  neuralgia ;  but  it  is  inferior  to  aconite.  A  small  lump 
of  opium  in  contact  with  an  aching  tooth  pulp  will  relieve  the 
pain,  or  the  powder  may  be  used  for  the  same  purpose.    In  the 


OPIUM.  421 

form  of  wiae  and  tincture,  opium  is  serviceable  in  odontalgia, 
periodontitis,  inflamed  gums  and  mucous  membrane  of  the 
mouth;  in  injections,  for  alveolar  abscess,  when  it  is  often 
used  in  combination  with  tincture  of  iodine.  The  wine  of 
opium  is  a  more  soothing  and  pleasant  application  than  the 
tincture  of  opium. 

ViNUM  Opii — Wiut:  of  Opium,  is  obtained  by  macerating  two 
ounces  of  powdered  opium,  together  with  cinnamon  and 
cloves,  in  one  pint  of  white  wine.     Dose,  ITLv  to  5j- 

Dental  Uses. — Employed  as  a  soothing  and  anodyne  appli- 
cation to  inflamed  and  tender  gums  and  mucous  membrane, 
odontalgia,  ulcerations  of  mouth,  alveolar  abscess,  periodon- 
titis, pulpitis,  etc.  Dr.  W.  H.  Atkinson  recommended  wine 
of  opium  by  means  of  injection,  into  pockets  and  cavities, 
where  such  exist,  in  case  of  aching  gums  or  teeth. 

Dover's  Powder — Pulvis  ipecacuanh(B  et  opii.  Dose,  gr.  x. 
Ten  grains  contain  one  grain  each  of  ipecac  and  of  opium,  and 
eight  grains  of  sugar  of  milk.  For  influenza  or  "  common 
cold,"  a  dose  of  Dover's  powder  taken  at  bed-time,  with  such 
adjuncts  as  warm  clothing,  hot  drinks,  foot-baths,  etc.,  to  pro- 
mote profuse  diaphoresis,  proves  very  effective.  Ten  grains 
at  bed-time  is  also  a  very  serviceable  remedy  for  inflammations 
of  the  peridental  membrane. 

TiNCTURA  Opii — Tincture  ofOpitim — laudanum,  is  composed 
of  powdered  opium,  Siiss  ;  diluted  alcohol,  Oj.  Dose,  TTLv  to 
ITLxxx ;  25  drops  are  equivalent  to  one  grain  of  opium.  Its 
strength  increases  with  age.  Tincture  of  opium  in  hot  water 
(f5ij,  to  aquae  ferv.  fSx),  held  for  some  minutes  in  the  mouth, 
is  useful  in  peridental  inflammation. 

One  drachm  of  the  tincture  contains  120  drops.  The  dental 
uses  are  the  same  as  for  wine  of  opium,  but  the  latter  is  the 
most  pleasant  application  for  the  mouth. 

TiNCTURA  Opii  Camphorata — Camphorated  Tincture  of 
Opium — paregoric  elixir,  is  prepared  by  macerating  sixty 
grains  of  opium  in  two  pints  of  diluted  alcohol,  with  sixty 
grains  of  benzoic  acid,  a  fluidrachm  of  oil  of  anise,  two  ounces 
of  clarified  honey,  and  forty  grains  of  camphor.     Dose,  f5j  to 


422 


DENTAL   MEDICINE. 


foj  or  a  tablespoonful,  containing  a  little  less  than  one  grain  of 
opium.  Dose  for  an  infant,  gtt.  v.  to  xx.  This  is  an  agreeable 
preparation  for  children. 

TiNCTURA  Opii  Deodorata — Dcodorized  Tincture  of  Opium, 
is  composed  of  the  watery  extract  of  opium,  washed  with  ether, 
which  is  afterward  separated,  and  the  residue  dissolved  in 
water  and  mixed  with  enough  alcohol  to  preserve  it.  This 
preparation  of  opium  is  free  from  the  narcotina  and  many- 
other  injurious  ingredients  of  opium,  and  is  a  valuable  pre- 
paration.    Dose^  TTLv  to  TTlxxx. 

DENTAL  FORMULAE. 


A  Stimulating  Injection  for  Abscess  of 

Antrum. 

J.  S.  Smith. 

R.     Glyceringe f^j 

Tinct.  opii  camph  .    .  f.^ij 
Eau  de  cologne   .    ,    .  3  iv.      M. 
SiGNA. — Inject  daily. 

For  Infantile  Diarrhcea  During  Denti- 
tion. 

When  there  is  a  tendency  to  an  acid 
fermentation  of  the  food. 

Dr.  Jas.  W.  White. 

First  give  a  grain  of  bicarbonate  of 
sodium  or  of  potascium  with  anise,  cin- 
namon, or  caraway,  with  each  meal. 
If  undigested  food  or  vitiated  secretions 
in  alimentary  tract  are  suspected,  a  dose 
of  castor  oil  and  aromatic  syrup  of 
rhubarb  in  equal  portions — dose,  a 
teaspoonful ;  if  torpidity  of  liver,  a  few 
doses  at  intervals  of  two  hours,  of  the 
twelfth  or  sixteenth  of  a  grain  of  calomel 
with  one  or  two  grains  of  sodium  bicar- 
bonate.    If  the   diarrhoea   persists  use 


the  following,  first  prohibiting  the  use 
of  farinaceous  or  milk  food  : 

R .     Tinct.    opii gtt.  viij 

Bismuth  subnitrat.  .    .  ^j 
Mucilag.    acaciffi.  .    .  f^ss 
AquEe  menth.  pip.  .    .  f^iss.      M. 
SiG. — A  teaspoonful  every  3  hours  to  a 
child  6  months  old.     Opium  is  indi- 
cated only  after  all  offending  matters 
have  been  expelled  from  the  alimen- 
tary canal. 

For  Infantile  Diarrkma  during  Denti- 
tion. 
If  it  is  due  to  relaxation  from  long 
continued  warm  weather,  or  following 
cholera  infantum,  and  no  fever  is 
present. 

Dr  Jas.  W.  White. 
R .     Tinct.  opii  camph.  .    .    .  f ^j 
Ext.  hsematoxyli.     .    .    .  gr.  xvj 
Mist  cretse 

Aquae    cinnamomi    .  aa  .  f^j.  M. 
SiG. — A  teaspoonful  in  water  every  4 
hours  for  a  child  six  months  old. 


PAPAIN  OR  PAPAIVA. 


Source. — Papain  is  a  ferment  obtained  from  the  Carica 
papaya,  from  which  exudes,  on  incision,  a  white,  slightly- 
astringent  and  milky- juice,  which  contains  the  papain. 


PARALDEHYDE.  423 


Medical  Properties  and  Action. — Papain  is  a  digestive  fer- 
ment like  pepsin,  its  active  digestive  power  causing  the  solu- 
tion of  albuminous  substances.  Catillon  denies  that  it  is  a 
true  ferment,  with  power  to  convert  albuminoids  into  peptones; 
hence  it  cannot  be  substituted  for  pepsin  in  affections  of  the 
stomach. 

Therapeutic  Uses. — It  is  an  active  solvent  of  false  mem- 
branes, inte.stinal  worms,  ascarides  and  taenias,  hence  it  is  em- 
ployed in  diphtheria,  ascarides,  vermiculares,  tapeworm. 
Locall)^,  like  pepsin,  it  is  employed  in  the  form  of  injections 
made  with  the  hypodermic  syringe,  in  the  treatment  of  fatty 
tumors  and  other  benign  growths,  and  to  retard  the  growth 
of  cancerous  and  other  malignant  tumors,  the  solution  being 
injected  well  into  the  substance  of  the  tumor. 

Dental  Uses. — Papain  is  employed  in  the  treatment  of 
tumors  of  the  mouth,  both  benign  and  malignant,  the  solution 
being  injected  into  the  substance  of  the  growth  by  means  of  a 
hypodermic  syringe. 

PARALDEHYDE— PARALDEHYDE. 

Formula. — CgHjjOj. 

Derivation. — Paraldehyde  is  a  polymeric  modification  of  al- 
dehyde (CsH^O).  It  is  a  colorless  liquid  of  an  ethereal  odor, 
pungent  taste  and  insoluble  in  eight  parts  of  water,  which  is 
a  proper  menstruum.  It  is  frequently  combined  with  chloro- 
form, oil  of  almonds  and  syrup  of  orange  peel,  or  cinnamon. 

Medical  Properties  and  Therapeutic  Uses. — Paraldehyde  is 
an  efficient  hypnotic,  similar  in  its  effects  to  chloral,  although 
the  sleep  caused  by  it  is  not  so  deep  nor  so  prolonged.  As  it 
does  not  weaken  or  paralyze  the  heart  or  lungs,  it  is  consid- 
ered to  be  safer  than  chloral.  It  is  employed  as  a  hypnotic 
in  fevers,  rheumatism,  gout,  prurigo,  insomnia,  hysterics, 
delirium  tremens,  some  cases  of  neuralgia,  and  all  mental  and 
nervous  disorders.  It  is  also  used  as  an  expectorant. 
Poisonous  doses  cause  respiratory  paralysis.  The  action  of 
paraldehyde  upon  digestion  is  as  follows : 

a.  Large  quantities  considerably  accelerated  the  digestion 


424  DENTAL   MEDICINE. 


of  fibrin,  and  that  the  rate  of  this  acceleration  was  distinctly 
in  ratio  with  the  quantity  used. 

b.  Small  quantities  also  increased,  but  to  a  less  degree,  the 
digestion  of  fibrin. 

c.  Putrefaction  was  prevented  by  the  larger  quantities  of 
paraldehyde,  and  was  delayed  by  the  smaller  quantities. 

Dose. — Of  Paraldehyde,  TTL  xv  to  f5j,  repeated  if  necessary. 

PEPSI  NUM— PEPSIN. 

Source. — Pepsin  is  obtained  by  digesting  the  mucous  mem- 
brane of  the  stomach  of  the  pig,  calf  or  sheep,  which  has 
been  scraped  off,  chopped  finely,  and  macerated  for  several 
days  in  water,  in  a  solution  of  muriatic  acid,  from  which  the 
pepsin  is  precipitated  with  chloride  of  sodium.  The  medicinal 
preparation  is  in  the  form  of  a  nitrogenized,  light,  amorphous, 
grayish-white  or  fawn-colored  powder,  soluble  in  water  and 
alcohol,  and  of  a  peculiar  odor  and  bitter,  nauseous  taste. 
When  quite  pure,  it  is  both  tasteless  and  inodorous.  When 
decomposed  by  heat  it  no  longer  possesses  digestive  proper- 
ties, and  much  of  what  is  sold  is  almost  or  wholly  inert. 
Pure  pepsin  is  an  artificial  digestive. 

Medical  Properties  and  Action. — Pepsin  is  an  essential  con- 
stituent of  the  gastric  juice,  and  digests  the  nitrogenous  con- 
stituents of  the  food,  converting  them  into  peptones.  Taken 
internally,  as  a  medicinal  preparation,  pepsin  increases  the 
appetite  and  allays  irritability  of  the  stomach.  It  should  be 
administered  immediately  before  meals,  and  no  hot  food 
taken  for  some  time  afterward. 

Therapeutic  Uses. — Pepsin  is  employed  in  dyspepsia,  gastral- 
gia,  obstinate  vomiting,  infantile  diarrhoea,  apepsia  of  infants, 
vomiting  of  pregnancy,  cancer  and  chronic  ulcer  of  the  stom- 
ach, anaemia,  chlorosis,  atrophy,  etc.  Externally,  it  is  injected 
into  cancerous  tumors  and  morbid  growths  with  the  hypoder- 
mic syringe,  to  retard  their  progress. 

Dose. — Of  pepsin  suspended  in  syrup,  saccharated  pepsin — 
Pepsinum  saccharatum — gr.  v  to  gr.  x.     Syrup  of  orange  peel 


PEPSIN.  425 

will  disguise  its  odor.  Vimim  Pepsini.  Dose,  5ss  to  5j. 
Glyccrinuin  Pepsini.     Dose,  3ss  to  5j. 

Both  the  saccharated  pepsin  and  the  glycerole  are  un- 
changeable. 

Pepsin  appears  to  be  especially  efficient  in  cases  of  children  ; 
and  when  pepsin  and  a  small  quantity  of  hydrochloric  acid 
are  added  to  animal  broths  given  by  the  rectum,  in  cases  where 
food  is  rejected  by  the  stomach,  such  nourishment  is  very 
beneficial. 

Dental  Uses. — In  dental  practice,  pepsin  is  successfully  em- 
ployed in  the  treatment  of  putrid  pulps  of  teeth,  as  an  anti- 
septic and  deodorizer.  In  the  form  of  a  thin  paste  made  by 
mixing  pepsin  with  water  containing  some  two  per  cent,  of 
hydrochloric  acid,  it  is  introduced  into  the  pulp  canal  after 
the  removal  of  the  decomposed  matter,  and  confined  by  a 
temporary  filling  in  the  crown  cavity,  being  permitted  to  re- 
main for  twenty-four  hours,  when  it  is  removed  and  the  canal 
syringed  with  tepid  water,  and  if  necessary,  the  application  of 
the  pepsin  paste  repeated  until  the  odor  of  decomposition  can 
no  longer  be  detected.  Pepsin,  in  the  form  of  the  paste,  is 
also  applied  to  partially  decomposed  dentine,  which  may,  for 
good  reasons,  be  permitted  to  remain  immediately  over  the 
pulp  of  the  tooth,  and  the  action  of  the  pepsin  is  confined  to 
dead  matter  alone.  The  hydrochloric  acid  and  pepsin  paste 
has  also  been  recommended  for  devitalizing  the  pulps  of  teeth 
where  rapid  action  is  not  desired,  the  quantity  employed  being 
about  one-fifteenth  of  a  grain. 

DENTAL  FORMULAE. 

For  Suppurating  Dental  Pulps.  For  Indigestion. 

Oakley  Coles.  Mialhe. 

R .     Acidi  hydrochlorici  .  .    .  TTLJ  B  •     Pepsini .^  iss 

Aqiue  destillatK  ....  TIXxl  Aquae f  .5  viss 

Pepsini  porci q.s.  Vlni  xerici f  ,^  xiiss 

To  make  a  paste  Alcoholis f ,!?  iij 

r.  r~    I  I-    1  .  .•  Sacchari .^j. 

SiG.NA. — To  be  applied  to  suppurating 

pulps.  .SiGNA. — A   taljlcspoonful    immediately 

after  each  meal. 


426  DENTAL  MEDICINE. 


Ingluvin  is  a  ferment  prepared  from  the  gizzard  of  the 
chicken,  and  its  effects  are  analogous  to  those  of  pepsin.  It 
is  employed  internally  for  indigestion,  etc.,  and  to  prevent 
nausea  and  vomiting. 

Dose. — Of  Ingluvin,  grs.  v  to  9j. 

PEROXIDE  OF  HYDROGEN^HYDROGEN  PEROXIDE. 
HYDROGEN   DIOXIDE. 

Formula. — HgOg . 

Derivation. — Peroxide  of  Hydrogen  is  obtained  by  rubbing 
up  peroxide  of  barium  with  distilled  water,  so  as  to  form  a 
liquid  paste,  which  is  added  gradually,  with  constant  stirring, 
to  distilled  water  acidulated  with  one-third  of  its  weight  of 
hydrochloric  acid,  contained  in  a  vessel  immersed  in  a  freezing 
mixture.  When  the  muriatic  acid  is  saturated,  a  fresh  quan- 
tity of  the  acid  in  a  concentrated  state  is  added,  and  then 
more  of  the  peroxide  of  barium,  and  the  operation  repeated 
till  the  solution  will  hold  no  more  chloride  of  barium,  which 
is  deposited  by  a  mixture  of  ice  and  salt,  except  a  small  por- 
tion which  is  gotten  rid  of  by  adding  sulphate  of  silver  to  pre- 
cipitate the  sulphate  of  baryta  and  chloride  of  silver.  The 
filtered  liquid  is  then  concentrated  by  sulphuric  acid,  and  the 
water  rising  in  vapor  is  absorbed  and  protoxide  of  hydrogen 
is  obtained  nearly  pure,  in  the  form  of  a  colorless  liquid  of  a 
fluid  consistence. 

Medical  Properties  and  Action. — Dr.  B.  W.  Richardson,  of 
London,  found  that  peroxide  of  hydrogen  imparts  oxygen 
to  venous  blood  deprived  of  its  fibrin,  with  an  increase  of  heat 
and  a  change  of  the  color  to  red.  Fibrin  and  cellular  tissue 
cause  it  to  evolve  oxygen,  while  albumen,  gelatin,  urea,  and 
cutaneous  tissue  have  no  effect  upon  it. 

Topically,  it  acts  by  imparting  oxygen  to  the  diseased 
tissues,  and  thus  destroying  them.  It  arrests,  immediately  and 
definitely,  all  fermentation  due  to  an  organized  ferment,  and 
Bert  and  Reynard  found,  on  the  other  hand,  that  soluble 
ferments  do  not  seem  to  be  affected  by  it ;  saliva,  diastase,  the 
gastric  and  pancreatic  fluids,  continue  to  act  in  solutions  con- 


PEROXIDE   OF   HYDROGEN.  427 


taining  peroxide  of  hydrogen.  The  conclusions, therefore,  that 
these,  as  well  as  Peau  and  Baldy,  have  arrived  at  are  that 
peroxide  of  hydrogen,  even  when  very  dilute,  arrests  fermen- 
tations due  to  the  development  of  living  organisms,  and  the 
putrefaction  of  all  substances  which  do  not  decompose  it;  that, 
containing,  according  to  circumstances,  from  two  to  six  times 
its  volume  of  oxygen,  it  is  capable  of  advantageously  replacing 
alcohol  and  carbolic  acid ;  that  it  can  be  employed  externally 
for  dressing  wounds  and  ulcerations  of  all  natures,  in  injections 
and  in  vaporizations,  and  internally;  that  the  results  obtained 
in  the  case  of  the  largest  operations,  up  to  the  present,  are  in 
the  highest  degree  satisfactory  ;  that  not  only  fresh  wounds,  but 
old  ones,  proceed  rapidly  to  cicatrization,  and  reunion  by  first 
intention  appears  to  be  encouraged  by  its  use  as  a  dressing ; 
that  the  general  as  well  as  the  local  state  appears  to  be  favor- 
ably influenced  ;  that  the  advantages  over  carbolized  water  are 
its  not  having  any  poisonous  effect  nor  unpleasant  odor,  while 
its  application  is  entirely  painless.  It  is  an  effective  application 
in  a  large  class  of  diseases  in  which  mucous  membrane  tissue 
is  chiefly  affected,  and  for  cleansing  purposes  is  considered  to 
be  unequaled.  Dr.  Prince  remarks  that  a  drop  of  pus  will 
decompose  peroxide  of  hydrogen  and  liberate  nascent  oxygen, 
which  adheres  to  and  attacks  all  the  adjacent  tissues  for  which 
it  has  an  affinity,  and  it  thus  becomes  a  powerful  bacterial 
destroyer.  Peroxide  of  hydrogen  for  surgical  use  must  be 
entirely  neutral,  as  that  obtained  generally  often  contains 
sulphuric  acid,  so  that  its  use  would  not  be  without  danger. 

Therapeutic  Uses. — Peroxide  of  hydrogen  is  employed  as  an 
internal  remedy  in  low  forms  of  fevers,  chronic  and  subacute 
rheumatism,  whooping  cough,  chronic  bronchitis,  dyspepsia, 
as  it  improves  digestion,  diabetes,  etc.,  etc.  Locally  employed, 
peroxide  of  hydrogen  is  an  effective  antiseptic,  and,  according 
to  Dr.  Prince,  owes  its  importance  as  a  therapeutic  agent  to  its 
instability,  being  decomposed,  in  the  presence  of  a  variety  of 
agents,  into  water  and  oxygen.  He  considers  peroxide  of 
hydrogen  to  be  inferior  to  iodoform  as  an  antiseptic,  but  it 
resembles    it    in    producing    little    or  no  irritation  when  used 


428  DENTAL   MEDICINE. 


about  tender  organs,  and  can  be  successfully  applied  in  an 
unirritating  form,  so  that  it  comes  in  contact  with  and  destroys 
diseased  germs  ;  hence  its  applicability  to  dental  uses,  and  in 
ocular  and  oral  therapeutics,  as  in  gonorrhceal  ophthalmia  and 
mastoid  abscess,  for  example.  Peroxide  of  hydrogen  acts 
very  promptly  and  beneficially  in  feeble,  flabby,  or  ill-condi- 
tioned ulcers,  chancre,  and  diphtheritic  sores,  ozaena,  wounds, 
both  fresh  and  putrid,  etc.,  etc.  Peroxide  of  hydrogen 
appears  to  have  no  injurious  effect  upon  animal  cells,  but  has 
a  very  energetic  destructive  action  upon  vegetable  ,„cells — 
microbes.  It  has  no  toxic  properties,  and  is  also  harmless  when 
given  by  the  mouth.  It  is  especially  applicable  in  the  treat- 
ment of  diseases  caused  by  germs  if  the  microbian  element  is 
directly  accessible,  and  is  particularly  useful  in  the  treatment 
of  infectious  diseases  of  the  mouth  and  throat. 

To  obtain  the  best  results  from  peroxide  of  hydrogen,  it 
should  be  kept  in  a  cool  place,  tightly  stopped,  and  when  re- 
quired for  use  as  much  as  desired  should  be  poured  from  a 
large  bottle  into  a  small  receptacle,  and  only  the  quantity  to 
be  used  at  a  time  be  exposed  to  the  light.  For  injection,  a 
small  glass  or  rubber  syringe  should  be  used,  as  contact  with 
metal  destroys  its  utility. 

As  a  test  for  peroxide  of  hydrogen  Dr.  Chas.  Mayr  suggests 
a  paper  saturated  with  a  mixed  solution  of  iodide  of  potassium 
and  dithionate  of  soda.  The  peroxide  of  hydrogen  liberates 
the  iodine  in  the  iodide  of  potash,  but  this  liberated  iodine  is 
immediately  seized  by  the  dithionate  of  soda  and  a  colorless 
solution  is  the  result.  But  if  enough  of  the  peroxide  is  ap- 
plied the  blue  spot  will  appear,  because  more  iodine  is  liberated 
than  can  be  used  in  oxidizing  the  dithionate  of  soda  to 
tetrathionate  of  soda  ;  to  make  the  reaction  more  pronounced 
still,  a  little  starch-paste  is  added.  By  this  paper  one  drop  of 
peroxide  of  hydrogen  of  12  volumes  of  oxygen,  produces  a 
blue  spot  in  20  seconds  ;  with  six  volumes  in  from  one  to  two 
minutes ;  and  with  four  volumes  no  blue  spot  is  produced, 
only  possibly  a  blue  rim. 

Dose. — Of  peroxide  of  hydrogen,  gr,  iij  to  gr.  v,  containing 


PEROXIDE   OF  HYDROGEN.  429 

six  times  its  volume  of  oxygen,  or  two  per  cent.  In  opera- 
tions on  mucous  membrane,  a  strong  solution  of  peroxide  of 
hydrogen — twelve  per  cent. — greatly  facilitates  by  decolorizing 
the  blood  and  by  its  cleansing,  styptic  action. 

Dental  Uses. — Peroxide  of  hydrogen  is  a  valuable  remedy 
in  dental  therapeutics,  especially  in  the  treatment  of  alveolar 
abscess,  alveolar  pyorrhoea,  ulcerations  of  oral  mucous  mem- 
brane, gangrene  or  cancrum  oris,  fungous  growths,  bleaching 
discolored  teeth,  putrescent  pulps,  etc.,  etc. 

A  twenty  per  cent,  solution  has  been  recommended  for  the 
arrest  of  hemorrhage  after  tooth  extraction,  by  Mr.  Bennett. 

Dr.  A.  H.  Prince's  method  of  treatment,  in  the  case  of  alve- 
olar abscess,  illustrates  the  properties  of  peroxide  of  hydrogen. 
"The  septic  abscess  is  caused  to  heal  by  one  application  made 
in  the  following  manner :  After  removing  the  pulp  and  pass- 
ing a  broach  through  the  canal  of  the  root  into  the  abscess 
cavity  a  drop  of  the  liquid  is  injected  by  means  of  Farrar's 
syringe.  The  cavity  of  the  crown  is  then  immediately  closed 
with  softened  gutta  percha,  before  which,  under  pressure  of  the 
finger,  the  liquid  is  driven  into  the  abscess  cavity.  Upon 
coming  into  contact  with  the  pus  in  the  fetid  cavity,  the  liber- 
ated gas  permeates  it  throughout,  and  by  the  continued  evolu- 
tion of  the  gas  the  cavity  is  emptied  of  its  contents,  which 
boil  out  at  the  fistulous  opening  so  thoroughly  mixed  that  the 
appearance  is  that  of  foam  or  froth  ;  while  the  remnant  thus 
removed  is  rendered  so  thoroughly  antiseptic  that  the  healing 
process  proceeds  uninterruptedly."  Dr.  A.  W.  Harlan  has 
successfully  employed  the  peroxide  of  hydrogen,  in  connec- 
tion with  iodide  of  zinc  solution  and  other  agents,  in  the  treat- 
ment of  alveolar  pyorrhoea. 

Dr.  Harlan's  treatment  is  as  follows :  First  pack  the  pus 
pockets  with  iodoform  and  eucalyptus,  iodoform  and  oil  of 
cinnamon,  or  thoroughly  .syringe  with  a  one  to  three  grain 
solution  to  the  ounce  of  water  of  chloride  of  alumina,  a  method 
which  will  relieve  the  .suffering  and  reduce  the  .swollen  gums 
to  their  normal  size.  In  three  or  four  days  the  sanguinary 
deposits  may  be  removed,  and  the  edges  of  the  alveoli  scraped 


430  DENTAL   MEDICINE. 


or  burred  off.  The  pockets  are  then  syringed  with  peroxide 
of  hydrogen,  and,  after  drying  the  gums,  injected  with  one, 
two  or  three  drops  of  a  solution  of  iodide  of  zinc,  grs.  xii  to 
the  ounce  of  water.  On  the  fourth  day  the  gums  are  carefully 
dried,  and  a  fine  cone  of  cotton  or  bibulous  paper  moistened 
with  peroxide  of  hydrogen,  gently  pressed  into  each  pocket. 
If  any  effervescence  occurs,  it  denotes  the  presence  of  pus, 
when  each  pocket  should  again  be  injected  with  the  iodide  of 
zinc  solution.  In  chronic  cases,  after  syringing  with  the  per- 
oxide of  hydrogen,  a  stronger  injection  of  the  iodide  of  zinc 
(grs.  xxiv  to  the  ounce  of  water)  is  made,  and  in  very  bad  or 
hopeless  cases  even  a  stronger  solution  of  the  zinc  (grs.  xlviii 
to  the  ounce  of  water) ;  and  when  the  gingival  margins  pre- 
sent a  ragged  border  or  cone-shaped  slit,  pure  granular  iodide 
of  zinc  is  applied  to  such  edges.  The  injection  into  the  pocket 
is  repeated  every  fourth  day.  In  some  cases  constitutional 
treatment  is  also  required.  Peroxide  of  hydrogen  has  also 
been  successfully  used  for  bleaching  discolored  teeth,  first 
adjusting  the  rubber  dam  and  repeatedly  washing  out  the 
cavity  with  the  peroxide  of  hydrogen,  and  then  carefully  dry- 
ing with  the  hot-blast  syringe.  A  small  quantity  of  chloride 
of  alumina  is  then  placed  in  the  cavity  and  moistened  with 
peroxide  of  hydrogen  and  allowed  to  remain  for  five  minutes 
and  then  washed  out  with  a  clear  solution  of  sodse  biboras. 

To  Render  the  Hands  Aseptic. — Dr.  Noble  says :  Trim  the 
nails  reasonably  short,  and  clear  the  subungual  spaces  with 
the  knife  blade.  Then  thoroughly  wash  the  hands  and  fore- 
arms in  warm  water,  a  good  lather  being  made  with  soap, 
and  a  stiff  brush  vigorously  applied.  Renew  the  water  three 
times.  Next  soak  the  hands  in  a  saturated  solution  of  oxalic 
acid.  According  to  circumstances  the  finger  tips  are  then 
soaked  in  peroxide  of  hydrogen.  For  the  final  bath,  cor- 
rosive sublimate  solution,  i  to  looo,  is  employed ;  allow  the 
hands  to  remain  in  this  solution  three  minutes. 


PHENACETINE.  ^3j 

Antiseptic  and  Stimulant  Mouth  Wash.  Por  Alveolar  Pyorrhea 

i-or  use  in  Alveolar  Pyorrhcea,  etc    etc  ^ 

^     ^  .       .     •  Dr.  A.  W.  Harlan. 

Dr.  Ch.\s.  B.  Atki.nso.x.  d       u  j 

„  K  •     Hydrogen  perox  .    .    .        s  j 
R.     Hydrogen  perox.  .    .    .   ^^^iv  Corrosive  sublimate  .    .    .    5      M 

Tinct.  calendula    •    •    .  SU-     M.  SiGN..._Inject  into  pockets  unttl 'they 
SiGNA.-Lse  daily.  ^^  f^^^  ^f  ^j,  j-^^^j^  ^^^^^^_ 

PHENACETINE-PARAACETPHENITIDINE. 

Fonmda.—Z^  H,>  O  Cj  H^ 

NH(C0-CH3.) 

Medical  Properties  and  Therapeutic  f/^rj.— Phenacetine  is 
slightly  soluble  in  water,  but  freely  soluble  in  alcohol,  and  has 
proven  to  be  a  most  reliable  antineuralgic  without  deleterious 
effects.  It  causes  no  nausea,  vomiting  or  diarrhoea ;  no  col- 
lapse, no  cyanosis  or  depressing  after  effects.  It  is  thought 
to  produce  its  effects  by  slowly  dissolving  in  the  lactic  acid  of 
the  stomach. 

Prof  Rumpf  considers  phenacetine  to  be  not  a  narcotic,  but 
an  antineuralgic  acid  from  its  strong  antipyretic  action. 

The  mode  of  action  is  probably  a  direct  influence  on  the 
central  nervous  system— that  of  the  vaso-motor  more  espe- 
cially, for  phenacetine  acts  especially  on  the  vaso-motor  neu- 
roses, which  indicates  a  powerful  effect  on  the  circulation. 
Phenacetine  is  a  strong  analgesic,  and  thought  to  be  more 
powerful  in  its  action  than  either  antipyrine  or  antifebrin,  and 
it  acts  very  rapidly  notwithstanding  its  insolubility  in  the'gas- 
tnc  juice.  About  twenty  minutes  after  its  administration  its 
effects  may  be  observed.  It  is  employed  in  the  various  forms 
of  neuralgia,  hemicrania,  acute  rheumatism,  vaso-motor  neu- 
roses, neurasthenia,  locomotor  ataxia,  etc.,  etc. 

Dose. — As  an  antineuralgic  the  dose  ranges  from  eight  to 
twenty-two  and  a  half  grains  (one-half  to  one  and  one-half 
grams).  Fifteen  grains  is  the  average  dose.  Good  results  are 
obtained  by  administering  phenacetine  in  gr.  v  doses,  once  in 
an  hour  until  gr.  xv-xx  are  taken. 

Dental  Uses. — Phenacetine  is  employed  in  neuralgias  of 
dental  origin,  acute  periodontitis,  and  pericemental  irritation. 


432  DENTAL   MEDICINE. 


PHOSPHATES  AND  PHOSPHITES. 

The  Phosphates  are  ingredients  of  most  of  the  animal  and 
vegetable  foods,  and  a  sufficient  amount  of  phosphorus  is, 
under  normal  conditions,  appropriated  by  digestive  action  for 
the  supply  of  the  system.  Every  part  of  the  body  contains 
phosphate  of  lime,  and  rickets  and  softening  of  the  bones  and 
defective  teeth  result  when  too  little  is  supplied  during  the 
formative  period.  The  blood,  saliva,  gastric  juice,  urine,  milk 
and  the  entire  intercellular  fluid  contain  phosphate  of  lime  in 
solution.  When  this  agent  is  administered  by  the  stomach, 
diffusion  into  the  blood  results  as  a  consequence  of  its  being 
to  some  extent  soluble  in  lactic  and  hydrochloric  acids;  hence 
it  is  very  essential  to  the  nutrition  of  the  body,  and  small 
doses  are  as  effective  as  large  ones,  as  all  in  excess  of  the 
quantity  soluble  in  the  acids  of  the  stomach  is  not  appropri- 
ated, but  passes  off  or  forms  concretions  in  the  intestines. 
Phosphate  of  sodium  is  also  a  constituent  of  the  blood,  and 
by  removing  morbid  states  of  the  mucous  membrane  it  pro- 
motes digestion  and  improves  nutrition  and  the  tone  of  the 
nervous  system.  Large  doses,  on  the  other  hand,  when  ad- 
ministered in  health,  will  impair  digestion.  Phosphorus  exists 
generally  as  a  phosphate,  and  has  a  strong  affinity  for  oxygen, 
compounds  being  rapidly  formed  in  the  stomach ;  but  some 
of  it  may  enter  the  blood  uncombined.  It  is  a  powerful  irri- 
tant poison,  the  dose  being  no  larger  than  j^  to  -^  of  a  grain. 

The  preparations  of  the  Phosphates  and  Phosphites  are : 

Syrupiis  Calcii  Lacto-phosphatis. — Syrup  of  the  lacto-phos- 
phate  of  lime.  Dose. — foj  to  foj.  (See  Syrup  of  lacto-phos- 
phate  of  lime.) 

Compound  Syrup  of  the  Phosphates. — Each  drachm  contains 
two  and  a  half  grains  of  phosphate  of  iron  and  one  grain  of 
phosphate  of  lime. 

Sodii  Phosphas — Phosphate  of  Sodium. — In  the  form  of  large, 
colorless,  transparent  prisms,  v.'ith  a  cooling  saline  taste,  feebly 
alkaline  and  no  odor,  and  a  slightly  alkaline  reaction.  Soluble 
in  six  parts  of  water  at  60°  F.  and  in  two  parts  of  boiling 
water.     Dose. — f5j  to  fSj. 


JABORANDI.  433 


Calcii  Phosphas  PrcEcipitatus. — Precipitated  Phosphate  of 
Lime.  In  the  form  of  a  white  powder,  with  no  taste  or  odor 
and  insoluble  in  water  or  alcohol.     Dose. — Gr.  ij  to  gr.  v, 

Syriiptis  HypophospJiitiini. — Syrup  of  Hypophosphites.  Com- 
posed of  hypophosphites  of  calcium,  sodium  and  potassium. 
Dose. — foj. 

Sodii  Pyrophosphas. — Pyrophosphate  of  Sodium.  In  the 
form  of  colorless,  translucent  prisms,  with  a  cooling  saline  taste 
and  a  feeble  alkaline  reaction,  but  no  odor,  soluble  in  water, 
but  insoluble  in  alcohol.     Dose. — f5ss  to  fSss. 

Calcii  Hypophosphis. — (See  Hypophosphite  of  Lime.) 

Sodii  HypopJiosphis — Hypophosphite  of  Sodium.  In  the  form 
of  small,  colorless  or  white  prisms,  or  a  white  granular  powder 
with  a  sweetish  saline  taste,  and  a  neutral  reaction,  and  solu- 
ble in  water.         Dose. — Gr.  v.  to  gr.  x. 

Therapeutic  Uses. — The  phosphates  are  useful  in  rickets, 
mollities  ossium,  non-union  of  fractures,  soft  teeth  of  children, 
caries  and  necrosis  of  bone,  anaemia  of  nursing  mothers, 
chronic  bronchitis,  leucorrhcea.  The  phosphate  of  soda  in 
bilious  sick  headache,  hepatic  colic,  jaundice,  carbuncles, 
boils,  etc.,  etc.  The  hypophosphites  in  phthisis,  emphysema, 
fibroid  lung,  chronic  tuberculosis,  dilated  bronchi,  skin  dis- 
eases, and  all  diseases  characterized  by  mal-nutrition.  Phos- 
phoric and  hypophosphoric  acids  are  frequently  combined 
with  many  vegetable  and  mineral  tonics.  The  hypophosphites 
fulfill  nearly  all  the  indications  of  phosphorus  itself. 

PILOCARPUS-JABORANDI. 

Source. — From  the  leaflets  of  the  Pilocarpus  pennatifolius,  a 
Brazilian  plant.  The  alkaloid  on  which  the  properties  of  the 
substance  depends  is  pilocarpine,  which  combines  with  acids 
to  form  salts.  Another  alkaloid  is  jaborine,  both  having  the 
same  chemical  composition,  C,iH,gN202,  and  pilocarpine 
"by  heat,  merely  by  concentration  of  an  acid  solution,"  is  con- 
verted into  jaborine  ;  washing  with  absolute  alcohol  will  sepa- 
rate them  when  united:  The  principal  preparations  are  :  Hy_ 
drochlorate  of  pilocarpine — pilocarpines  hydrochloras, — which 
28 


434  DENTAL   MEDICINE. 


is  in  the  form  of  white  crystals,  dehquescent,  with  a  slightly 
bitter  taste,  a  neutral  reaction,  and  no  odor.  It  is  very  soluble 
in  alcohol,  but  not  soluble  in  ether  or  chloroform;  and  the 
fluid  extract  of  pilocarp us — extractuin  pilocarpi  fluidum.  Bella- 
donna and  its  alkaloid  atropine  are  antagonistic  to  pilocarpine. 

Medical  Fropej^ties  and  Therapeutic  Uses. — Large  doses  of 
crude  jaborandi  cause  nausea  and  vomiting  on  an  empty 
stomach,  and  the  use  of  the  alkaloid  appears  to  have  the  same 
effect  under  similar  circumstances.  It  increases  the  perspira- 
tion and  saliva.  Ringer  stating  that  the  secretion  of  the  sali- 
vary glands  is  augmented  as  much  as  twenty-seven  fluid 
ounces  as  the  result  of  a  full  dose.  The  nauseating  effects  of 
the  alkaloid  pilocarpus  appear  to  depend  upon  its  action  on 
the  muscular  layers  of  the  stomach  and  intestines ;  and  the 
increased  secretion  of  the  mucous  membrane  doubtless  results 
from  the  stimulation  of  the  pancreas  and  the  glands  of  the 
mucous  membrane. 

Children  do  not  appear  to  experience  its  influence  to  the 
same  degree,  in  regard  to  salivation,  perspiration  and  tempera- 
ture, as  do  adults.  As  a  general  rule,  drowsiness  follows  the 
profuse  perspiration,  and  pallor  the  flushings  caused  by  the 
drug :  and  the  languor  and  debility  it  occasions  continue  for 
some  hours.  The  pupil  of  the  eye  is  contracted,  but  this 
organ  generally  recovers  from  its  diminished  vision  after  the 
space  of  one  hour  and  a  half.  Jaborandi  is  employed  in  drop- 
sies of  the  heart  and  kidneys,  mumps,  diseases  of  the  eye,  to 
increase  the  secretion*  of  milk,  diabetes  insipidus,  diphtheria, 
skin  diseases,  etc.  It  is  also  employed  in  ptyalism  with  ad- 
vantage, in  the  form  of  the  hydrochlorate  of  pilocarpine,  one- 
third  of  a  grain  three  or  four  times  daily. 

Dose. — Of  Infusion,  Infusum  Pilocarpi^  Sss  to  oij.  Of  Fluid 
Extract — Extr actum  Pilocarpi  Fluidimi,  5ss  to  oij-  Of  Tinc- 
ture— Tinctiira  Pilocarpi,  5ss  to  5ij.  Of  Hydrochlorate — Pi- 
locarpince  Hydrochloras,  gr.  ^2"  to  gr.  ss. 


JAMAICA   DOGWOOD.  435 


PINUS  CANADENSIS— ABIES  CANADENSIS, 

Hemlock,  hemlock  spruce  of  the  United  States  and  Canada. 
The  medicinal  portions  are  the  juice  and  bark.  The  concrete 
juice,  which  is  known  as  Plx  Canadensis — Canada  pitch,  is  a 
yellowish  or  faintly  greenish,  transparent,  viscid  liquid,  when 
fresh,  but  afterward  becomes  an  opaque,  reddish-brown,  hard 
and  brittle  mass,  which  contams  resin  and  a  volatile  oil.  It  is 
used  to  make  rubefacient  plasters.  The  bark  is  rough  and 
deeply  furrowed,  and  is  very  astringent,  possessing  properties 
similar  to  those  of  the  white-oak  bark.  An  extract  prepared 
from  the  bark  is  used  as  a  topical  astringent,  but  it  is  not  con- 
sidered to  have  any  advantages  over  other  common  vegetable 
astringents 

For  Inflamed  Mucous  Membrane,  and  for  Use  after  the  Removal  of  Salivary 
Calculus. 
A.  W.  Harlan. 

R  .     Pinus  canadensis  (white) 5  ss 

Aquae  rosEe ,f  iijss 

Eugenol KTLxxx.  M. 

SiGNA. — Use  as  a  lotion  or  on  a  tooth-brush,  three  times  daily. 

PISCIDIA  ERYTHRINA— JAMAICA  DOGWOOD. 

Source. — Jamaica  Dogwood  is  a  plant  indigenous  to  the 
West  Indies,  where  it  has  been  used  as  an  intoxicant  in  taking 
fish.  The  bark  is  the  officinal  portion,  and  is  smooth  and 
bright-colored. 

Medical  Properties  and  Action. — Jamaica  dogwood  is  a  pow- 
erful narcotic,  and,  in  a  measure,  tonic  and  diuretic.  Its  nar- 
cotic properties  are  supposed  to  be  superior  to  opium,  as  it 
does  not  cause  the  disagreeable  after-effects  common  to  that 
drug.  When  chewed,  Jamaica  dogwood  has  an  unpleasant, 
acrimonious  taste.  It  yields  its  virtues  to  alcohol,  but  not  to 
water.  Its  internal  use  is  generally  followed  by  a  sensation 
of  heat,  gradually  extending  to  the  surface,  and  succeeded  by 
profuse  perspiration,  with  profound  sleep.  In  large  doses  it 
produces  general  paralysis,  and  death  from  asphyxia.     It  has 


436  DENTAL   MEDICINE. 


been  used  as  a  substitute  for  morphine,  which  it  resembles  in 
many  respects. 

Therapeutic  Uses. — The  principal  use  of  Jamaica  dogwood 
is  in  neuralgia,  in  the  form  of  a  tincture  composed  of  Jamaica 
dogwood  5J,  rectified  spirits  fSiv.  It  is  effectual  in  acute  pains 
usually,  and  is  said  to  be  efficacious  in  lunacy,  and  cough  of 
phthisis. 

Dose. — Of  the  tincture  of  Jamaica  dogwood,  f5j. 

Dental  Uses. — Jamaica  dogwood,  in  the  form  of  the  tincture, 
is  efficacious  in  trigeminal  neuralgia,  and  in  odontalgia  result- 
ing from  an  irritable  pulp,  for  which  purposes  a  fluid  drachm 
in  cold  water  may  be  taken  internally,  and  externally  in  the 
case  of  odontalgia,  introduced  on  a  dossil  of  cotton  into  the 
carious  tooth. 

PLUMBI  ACETAS— ACETATE  OF  LEAD. 

SUGAR  OF  LEAD. 

Formula. — Pb2C2H302,  3H2O. 

Derivation. — Acetate  of  Lead  is  obtained  by  immersing  lead 
in  distilled  vinegar,  or  litharge  in  pyroligneous  or  crude  acetic 
acid ;  when  the  acid  has  become  saturated,  the  solution  is  per- 
mitted to  cool  and  crystallize. 

Acetate  of  lead  is  a  white  salt,  in  the  form  of  beautiful, 
brilliant,  needle-shaped  crystals,  like  long  prisms,  which 
effloresce  on  exposure  to  the  air.  It  has  a  sweet,  astringent 
taste,  and  an  odor  of  acetic  acid,  and  is  soluble  in  water  and 
alcohol. 

Medical  Properties  and  Action.  — Acetate  of  lead  is  sedative 
and  astringent,  checking  the  secretions  and  reducing  the  activ- 
ity of  the  capillary  system,  and  diminishing  the  force  and  fre- 
quency of  the  pulse.  Like  all  the  salts  of  lead,  it  is  an  irritant 
and  corrosive  poison,  causing  gastro-enteric  inflammation.  It 
requires,  however,  a  large  quantity  (not  less  than  half  an 
ounce)  of  the  acetate  of  lead  to  destroy  life,  as  much  of  it  is 
rejected  by  vomiting.  The  symptoms  of  lead  poisoning,  when 
the  lead  is  slowly  introduced  into  the  system,  are  loss  of  ap- 
petite and  strength,  wasting  of  flesh,  paleness  of  the  face,  con- 


ACETATE   OF  LEAD.  437 


stipation,  pain  in  the  joints,  dry  colic,  which  is  reHeved  by 
pressure,  neuralgia  of  the  abdominal  muscles,  contraction  of 
the  intestines,  belly  drawn  toward  the  spinal  column,  contrac- 
tion of  the  liver,  jaundiced  skin,  yellow  conjunctiva,  urine 
colored  with  biliary  coloring  matter,  a  blue  line  along  the 
margin  of  the  gum,  about  the  incisor  teeth ;  also  at  times  a 
bluish  discoloration  of  the  mucous  membrane  of  the  lips 
and  mouth,  dimness  of  vision,  paralysis  of  the  extensor 
muscles  of  the  fingers  and  arms,  death  resulting  from  the 
gradual  failure  of  nutrition  and  the  paralysis  of  the  muscles 
of  respiration. 

When  the  poisonous  dose  is  large,  there  is  intense  gastric 
irritation,  numbness,  paralysis,  coma  and  collapse.  Iodide  of 
potassium  in  large  doses,  also  Epsom  salts  and  sulphur  baths, 
are  the  antidotes  in  chronic  cases  of  lead  poisoning,  and  for 
the  lead  colic,  alum  in  doses  of  one  or  two  drachms  every 
three  or  four  hours,  dissolved  in  some  demulcent  liquid,  is 
considered  to  be  the  best  remedy.  For  the  treatment  of  lead 
paralysis,  strychnia  and  electricity  are  employed.  The  blue 
or  slate-colored  line  on  the  gums  is  supposed  to  be  due  to  a 
deposition  of  the  sulphide  of  lead. 

Therapeutic  Uses. — Acetate  of  lead  is  internally  adminis- 
tered in  dysentery,  diarrhoea,  cholera,  cholera  morbus, 
phthisis,  chronic  bronchitis,  pneumonia,  diseases  of  the  heart, 
hemorrhage  from  the  lungs,  stomach,  kidneys,  nose,  etc. ;  dis- 
eases of  the  eye,  erysipelas,  skin  diseases,  chronic  gastric  ca- 
tarrh, gastralgia,  pyrosis,  summer  diarrhoea  of  children,  humid 
asthma,  whooping  cough,  etc. :  but  the  danger  of  producing 
toxic  effects  must  be  remembered  in  its  internal  use. 

Externally,  solutions  of  lead  are  employed  to  relieve  super- 
ficial inflammations,  arrest  morbid  discharges,  and  allay  the 
pain  of  acute  inflammations.  Lead  should  not  be  given  with 
natural  waters  containing  lime,  carbonic  acid,  mineral  acids 
and  salts,  vegetable  acids,  or  vegetable  astringents,  iodide  of 
potassium,  and  preparations  of  opium. 

Dose. — Of  plunibi  acetas,  gr.  ss  or  j  to  gr.  v,  two  or  three 
times  a  day. 


438  .  DENTAL   MEDICINE. 


Liquor  Plumbi  Subacetatis  Dilutus — Diluted  Solution  of 
Subacetate  of  Lead. — Lead  water  is  composed  of  subacetate  of 
lead  solution,  f5ij ;  distilled  water,  Oj ;  and  is  a  mild  astringent 
and  sedative  when  applied  externally ;  it  is  never  prescribed 
internally.  It  arrests  discharges  from  suppurating  and  ulcer- 
ated mucous  surfaces,  and  promotes  the  resolution  of  acute 
superficial  inflammations. 

De7ttal  Uses. — Lead  water  is  employed  in  dental  practice,  to 
relieve  inflamed  gums  and  mucous  membrane  of  the  mouth ; 
as  an  application  to  indolent  and  foul  ulcers ;  also  in  the  treat- 
ment of  teeth  after  the  devitalization  and  removal  of  the  pulps, 
to  prevent  peridental  trouble. 

It  proves  serviceable  when  applied  to  chapped  hands  and 
lips.  A  good  ointment  for  such  a  purpose  is  composed  of  a 
combination  of  lead  water,  camphor,  white  wax  and  oil  of 
almonds. 

DENTAL    FORMULA. 

For  Acute  Inflammation  of  the  Mucous  For  Chapped  Hands  and  Lips, 

Membrane    of  the     Mouth    and  the       ^  _     yXo,.  plumbi  subacetatis 

'^«''"-  dilutus gvj 

R.     Plumbi  acetatis  .    .    .  3J  Camphorse gr.  xl 

Tinct.  opii gss  Ceris  albre ^viij 

Aquae §x.  M.  Olei  amygdala  dulcis.  Oj.  M. 

SiGNA. — Apply  as  a  lotion,  on  lint.  Y\2.t  cerat. 

_      „    -J    J -J-  SiGNA. — Apply  as  an  ointment. 

For  Fertodontitis.  ^^  ^ 

McQuiLLEN.  For  Inflamed    Gums    and  After   Tooth 

Rf  .        ,       ,.      ,        i  ,.•     -N-  Extraction. 

.     Liq.  plumbi  subacetatis  ^j 

Tinct.  opii    .    .        .    .     ^ij.      M.       B-     Plumbi  acetatis   .    .    .  gr.  xv 

SiGNA. — Apply  to  cavity  on  cotton  and  Tinct.  opii f^ij 

to  gum  externally.  Aquae f§iij-      M- 

SiGNA. — Use  as  lotion  and  mouth- wash. 

PODOPHYLLUM— MAY  APPLE. 

Source. — The  rhizoma  and  rootlets  of  Podophyllum  peltatum, 
or  May  Apple.  It  contains  the  alkaloid  berberine,  which  is 
also  peculiar  to  other  plants,  and  two  resinous  substances 
soluble,  one  in  alcohol  and  ether  and  the  other  in  alcohol  only, 
and  on  which  its  medicinal  properties  depend.  Both  are  purga- 
tives.    It  has  a  bitter  taste,  with  a  sense  of  acidity. 


CAUSTIC   POTASH.  439 


Medical  Properties  and  Therapeutic  Uses. — Podophyllum  is 
a  useful  cathartic  and  cholagogue.  In  cases  of  constipation, 
due  to  deficient  secretions  of  the  intestinal  canal  and  liver,  it 
is  a  useful  cathartic,  and  for  habitual  constipation  small  doses 
combined  with  belladonna  are  very  effective.  It  is  also  em- 
ployed in  catarrhal  and  malarial  jaundice,  ascites,  hemorrhoids, 
bleeding  from  stasis  of  the  portal  circulation,  and  torpidity  of 
liver,  as  a  substitute  for  calomel  and  blue  mass.  It  is  slow  in 
its  action  and  is  therefore  often  combined  with  other  cathartics. 
PodopJiyllin  is  the  resin  a  podophylli. 

Dose. — Of  Resina  Podophylli — Resin  of  podophyllum,  gr.  J 
to  gr.  j.  Of  Extr actum  Podophylli  Fliddiini — Fluid  extract  of 
podophyllum,  TTLj  to  5ss.  Oi  Abstractunt  Podophylli — Abstract 
of  podophyllum,  gr.  \  to  gr.  j. 

POTASSA  CAUSTICA— CAUSTIC  POTASH. 
HYDRATE  OF  POTASH FUSED  POTASH — OXIDE  OF  POTASSIUM. 

Fornnda. — H  KO. 

Derivation. — Caustic  Potash  is  prepared  by  boiling  a  solution 
of  potash  until  ebullition  ceases,  and  the  potassa  melts  or  as- 
sumes a  solidified  consistence,  when  it  is  poured  into  suitable 
moulds  and  kept  in  well-stoppered  bottles,  as  it  rapidly  deli- 
quesces when  exposed  to  the  air.  It  dissolves  in  water  and 
alcohol,  and  attracts  moisture.  Its  officinal  form  is  that  of 
sticks  of  a  white  and  somewhat  transparent  color,  but  upon 
exposure  to  the  air,  or  if  it  is  impure,  it  becomes  a  dingy  gray, 
greenish  or  bluish  color,  and  has  the  odor  of  slaking  lime. 
When  it  is  digested  in  alcohol,  so  as  to  free  it  from  such 
impurities  as  are  insoluble  in  alcohol,  it  is  called  alcoholic 
potassa. 

Medical  Properties  and  Action. — Caustic  potash  is  the  most 
powerful  caustic  and  escharotic  in  use,  and,  when  taken  inter- 
nally, is  a  corrosive  poison.  It  is  only  employed  externally. 
When  applied  to  a  part,  it  rapidly  destroys  its  vitality  to  a 
considerable  depth,  differing  in  this  respect  from  nitrate  of 
silver  (lunar  caustic),  as  the  latter  is  more  limited  in  its  action, 
and  does  not  liquefy  when  it  comes  in  contact  with  the  tissues. 


440  DENTAL   MEDICINE. 


From  the  penetrating  action  of  caustic  potash,  it  is  necessary 
to  use  it  \vith  great  care.  It  is  very  deliquescent,  which  is  a 
great  objection  to  its  use  in  some  cases,  but  when  mixed  with 
an  equal  quantity  of  lime,  the  deliquescent  action  is  in  a 
measure  prevented  ;  it  is  then  known  as  potassa  ciini  calce — 
potassa  with  lime,  and  is  in  the  form  of  a  grayish- white  powder, 
which  is  sometimes  made  into  a  paste,  under  the  name  of 
Vienna  Paste,  which  is  milder  and  less  deliquescent. 

Therapeutic  Uses. — Caustic  potassa  is  chiefly  employed  to 
open  abscesses,  and  in  the  treatment  of  chancres,  hospital  gan- 
grene, eczema,  malignant  growths,  to  arrest  the  sloughing  of 
carbuncles ;  in  tetanus,  applied  to  the  spine ;  bites  of  rabid 
animals  and  venomous  reptiles ;  phlegmons  and  incipient  car- 
buncles, to  arrest  their  progress ;  to  form  issues,  etc.  To 
prevent  its  coming  in  contact  with  neighboring  parts,  a  piece 
of  adhesive  plaster  is  used,  with  an  opening  corresponding  in 
size  to  the  surface  on  which  the  caustic  is  to  act.  When 
mixed  with  water,  in  the  proportion  of  caustic  potash,  5iss  to 
water,  fSij,  it  forms  a  rubefacient  solution. 

Dental  Uses. — In  dental  practice,  caustic  potassa  is  employed 
in  gangrene  of  the  mouth  (cancrum  oris),  malignant  growths, 
fungous  growths  of  gum,  ulcers,  etc. ;  for  opening  abscesses, 
when  it  is  not  prudent  to  use  the  lancet. 

POTASSIUM  BICARBONAS— BICARBONATE  OF  POTASSIUM. 

Formula. — K  H  CO3. 

Derivation. — Bicarbonate  of  potassium  is  obtained  by  pass- 
ing carbonic  acid  through  an  aqueous  solution  of  carbonate  of 
potassium,  until  it  is  completely  saturated.  The  solution  is 
then  filtered  and  evaporated,  the  product  being  bicarbonate  of 
potassium,  in  the  form  of  transparent,  colorless  crystals,  of  the 
shape  of  irregular  eight-sided  prisms.  It  is  inodorous,  with  a 
saline  and  somewhat  alkaline  taste,  and  is  soluble  in  water, 
but  insoluble  in  alcohol.  Its  incompatibles  are  acids  and 
acidulous  salts,  etc. 

Medical  Properties  and  Action. — Bicarbonate  of  potassium 


BROMIDE   OF   POTASSIUM.  441 

is  antacid,  diuretic  and  antilithic.  In  large  quantities  it  is  a 
corrosive  poison. 

Therapeutic  Uses. — It  is  employed  internally  in  acute  rheu- 
matism, gout,  and  uric  acid  lithiasis,  diseases  of  the  skin, 
calculous  affections,  etc.,  etc. 

Dose. — Of  bicarbonate  of  potassium,  gr.  v  to  3j. 

Dental  Uses. — Bicarbonate  of  potassium  is  employed  in 
dental  practice,  as  an  antacid,  a  solution  being  serviceable 
as  a  mouth-wash,  to  prevent  injury  to  the  teeth  from  acid 
medicines. 

DENTAL  FORMULAE. 
For  Facial  Neuralgia.  For  Neuralgia. 

Wales.  J.  E.  Garretson. 

R.    Potassii  bicarb    .    .    .    .   ^ss  R.    Ferri  sulphatis  exsic. 

Ext.  ergotas  fluidi    .    .    .  f^j  Potassii  carbonatis.  aa    .  gr.ccl 

Infusi  ergotze f^vj.   M.  Syrup  acaciae q.s.       M. 

SiGNA.— Two  tablespoonfuls  every  four  Ft.pil.     No.  loo. 

jjQyj.s_  SiGNA. — Begin   with  three  a  day  and 

increase    to    six;    take    several    hun- 
dred. 

POTASSI  BROMIDUM— BROMIDE  OF  POTASSIUM. 

Formula. — KBr. 

Derivation. — Bromide  of  Potassium  is  obtained  by  adding  a 
solution  of  pure  carbonate  of  potassium  to  a  solution  of  bro- 
mide of  iron.  The  iron  being  precipitated,  the  bromide  of 
potassium  is  obtained  from  the  solution  by  evaporation.  It  is 
in  the  form  of  white  crystals,  without  odor,  wholly  soluble  in 
water,  and  but  sparingly  soluble  in  alcohol,  and  having  a  pun- 
gent, saline  taste. 

Medical  Properties  and  Action. — Bromide  of  potassium  is 
stimulant,  sedative,  narcotic  and  antispasmodic,  and,  being  ab- 
sorbed into  the  system,  can  be  detected  in  the  blood,  urine, 
faeces  and  mucus.  If  administered  in  considerable  quantity, 
the  action  of  the  heart,  respiration,  and  the  temperature  are 
depressed,  and  although  in  some  cases  a  transient  excitement 
may  be  caused  by  large  doses,  the  effect  of  this  agent  is  to 
induce  a  sound  and  refreshing  sleep,  and  if  its  use  is  long 
continued,  a  constant  drowsiness  is  experienced.     Bromide  of 


442  DENTAL   MEDICINE. 


potassium  has  also  the  power  of  lessening  the  sensibility  to 
pain,  especially  causing  a  loss  of  sensibility  of  touch  in  the 
case  of  the  mucous  membrane  and  skin,  which  is  due  to 
the  local  action  of  the  salt  as  it  is  eliminated,  The  long- 
continued  use  of  this  agent  also  causes  a  loss  of  motion, 
and  if  it  is  injected  into  the  tissues  of  a  limb,  it  will  cause 
paralysis  of  motion  and  sensibility.  It  also  diminishes  the 
sexual  feeling,  and  the  condition  which  a  long  course  of  the 
bromides  develop  is  known  as  bromism,  which  is  characterized 
by  weakness  of  mind,  confusion,  headache,  pallor  and  anaemia, 
uncertain  gait,  etc. 

Therapeutic  Uses. — Bromide  of  potassium  is  employed  as  an 
internal  remedy  in  cerebral  affections,  acute  rheumatism, 
cholera  infantum,  sea-sickness,  vomiting  of  pregnancy;  affec- 
tions of  the  heart,  as  shown  by  increased  action;  neuralgia, 
maniacal  excitement,  tetanus,  strychnia  poisoning,  epilepsy, 
spasmodic  asthma,  spasmodic  cough,  etc.,  etc. 

Dose. — Of  bromide  of  potassium,  gr.  v  to  5j. 

Dental  Uses. — Bromide  of  potassium  is  a  useful  remedy  in 
infantile  convulsions  from  the  irritation  of  dentition,  and  is  also 
efficacious  in  preventing  such  conditions  by  relieving  the 
irritation ;  also  in  neuralgia,  due  to  diseased  teeth,  and  in 
facial  neuralgia  when  congestive  in  character. 

As  its  local  effect  is  to  diminish  sensibility,  it  has  been  ap- 
plied to  the  pharynx  and  velum  palati,  in  order  to  prepare 
such  parts  for  the  taking  of  impressions  for  artificial  palates, 
and  to  overcome  extreme  susceptibility  of  the  mucous  mem- 
brane of  the  roof  of  the  mouth  in  first  wearing  artificial  den- 
tures. For  such  purposes  the  agent  is  administered  in  one- 
half  drachm  doses  3  times  daily  for  two  or  three  weeks 
previously ;  or  doses  of  grs.  xx  to  xxx  may  be  given,  repeated 
two  or  three  times. 

DENTAL    FORMULA. 

For  Infantile  Diarrhcea  from  Reflex  Nervous  Impress io?is. 

Dr.  Jas.  W.  White. 

R .     Potassi  bromidi gr.  xviij  to  ^  ss 

Potassi  nitratis gr.  vj. 

Sacchari  lactis 3  ss.  M. 

Ft.  pulv.  vj.     S. — One  powder  every  3  or  4  hours  to  a  child  one  year  of  age. 


CHLORATE   OF  POTASSIUM.  443 


POTASSII  CHLORAS— CHLORATE  OF  POTASSIUM. 

FovDuila. — KCLO3. 

Derivation. — Chlorate  of  Potassium  is  obtained  by  passing 
an  excess  of  chlorine  through  a  solution  of  carbonate  of 
potassa  and  slaked  lime ;  the  chlorine  being  converted  into 
chloric  acid  by  the  hydrogen  of  the  lime  and  the  acid  com- 
bining with  the  potassa,  forming  chlorate  of  potassium.  It  is 
in  the  form  of  colorless  or  white  crystals,  of  a  pearly  lustre, 
altogether  soluble  in  distilled  water,  and  in  twelve  parts  of 
cold  and  two  parts  of  boiling  water.  It  is  inodorous,  with  a 
cool,  saline  taste,  and  when  applied  to  animal  fluids  does  not 
decompose  them  nor  undergo  any  change,  although  perfectly 
soluble  in  such  fluids.  It  is  absorbed  by  the  blood,  and  is 
eliminated  by  the  kidneys. 

Medical  Properties  and  Action. — Chlorate  of  Potassium  is 
detergent,  refrigerant,  diuretic  and  stimulant,  and  its  action  as 
a  refrigerant  and  diuretic  is  similar  to  that  of  nitrate  of  potassa. 
It  improves  the  appetite,  and  on  account  of  the  large  quantity 
of  oxygen  it  contains  has  been  employed  in  contaminated  con- 
ditions of  the  blood  as  an  oxidizing  agent.  Although  it  may 
be  administered  with  impunity  in  very  large  doses,  yet  exces- 
sive quantities  have  given  rise  to  gastro-enteric  inflammation, 
with  fatal  effects. 

Therape7itic  Uses. — Chlorate  of  potassium  is  employed  in 
continued  and  typhoid  fevers,  neuralgia,  croup,  diphtheria, 
sore  throat,  chronic  bronchitis,  phthisis,  scrofula,  erysipelas, 
scurvy,  mercurial  salivation,  etc.,  etc.  Externally,  it  is  em- 
ployed in  the  treatment  of  ozaena,  sore  throat  of  scarlatina, 
pharyngitis,  cancerous  sores,  ulcerated  surfaces,  fetid  and 
scrofulous  ulcers,  etc.,  etc.  Poisonous  symptoms  have  re- 
sulted from  the  habitual  use  of  chlorate  of  potassium,  and 
several  cases  of  death  have  been  recorded. 

Dose. — Of  chlorate  of  potassium,  gr.  v  to  .'»)j,  every  three  or 
four  hours;  for  children,  gr.  iij  in  sweetened  water  every  four 
hours  for  a  child  three  years  of  age ;  gr.  v  for  one  of  eight  or 
nine  years,  with  due  attention  to  the  bowels  and  constitution, 


444  DENTAL   MEDICINE. 


regulating  the  former  and  supporting  the  latter.  In  the  case 
of  teething  children,  gr.  ij  may  be  administered  to  a  child  of 
one  year  of  age. 

Troches  of  Clilorate  of  Potasshun  are  prepared  by  a  combi- 
nation of  chlorate  of  potassium,  ov;  sugar,  oxviij;  tragacanth, 
5ij ;  vanilla,  gr.  xxx ;  mixed  together  with  water  into  a  mass 
and  divided  into  480  troches,  each  of  which  contains  gr.  v.  of 
chlorate  of  potassium ;  useful  for  sore  throat,  etc. 

Dental  Uses. — Chlorate  of  potassium  is  a  valuable  agent  in 
dental  practice  as  an  internal  and  external  resolvent  and 
detergent  remedy  in  the  various  forms  of  stomatis, — inflam- 
mation of  the  gums,  aphthae  and  other  ulcerative  affections, 
gangrenous  stomatitis,  mercurial  stomatitis,  erysipelatous  in- 
flammation of  the  mouth,  scurvy,  ulcers  of  the  gums,  cheeks 
and  tongue,  abraded  surfaces  of  mucous  membrane,  second- 
ary syphilitic  ulcerations  of  the  mouth,  indolent  and  scrofu- 
lous ulcers,  etc.,  for  such  purposes  being  used  alone  in  the 
form  of  mouth-washes  or  gargles,  or  in  combination  with  tan- 
nic acid,  alum,  borax,  glycerine,  etc.  In  the  treatment  of 
mercurial  stomatitis,  great  benefit  is  derived  from  both  its 
internal  and  external  use.  For  the  inflamed  gums  of  teething 
children  it  is  employed  as  a  lotion,  with  beneficial  efifects. 
In  the  form  of  powder  it  is  a  useful  application  to  ulcerated 
and  abraded  surfaces.  A  simple  gargle  or  mouth-wash  may 
be  made  by  dissolving  one  drachm  of  chlorate  of  potassium 
in  four  ounces  of  water,  or  half  an  ounce  may  be  dissolved  in 
a  pint  of  water. 

DENTAL  FORMULiE. 

For  Inflamed  Gums  After  the  Extraction  For  Aphthous  and  Secondary  Syphilitic 

of  Teeth.  Ulceration  of  the  Mouth  and  Fauces. 

R.     Potassii  chloratis   .    .    .    ^ij  R.     Potass ii  chlorat  .    .    .    .  ^iv 

Tincturse  kramerise,  Aquse  destillatse  .    .    .    .  ^  x.     M. 

Glycerini  .    .  aa    .    .    .  f§ss  SiGNA. — To   be  used  as  an  antiseptic 

Aquae  rosae ^  viij.   M.  moutli  wash. 

SiGNA. — To  be  used  as  a  gargle  6  or  8  for  Ulceration  of  the  Mouth. 

times  daily,  to  harden  the  gums.  Bartholow. 

For  Ulcers  and  Suppurating  Wounds.  R.     Potassii  chloratis    .    .    .  ^] 

R.     Potassii  chloratis    .    .    .  ^]  Acidi  carbolici  .    .    .    .  .^ss 

Glycerini ^  iss    M.  Aquse  destillatse .   .    .    .  ^  iv.    M. 

SiGNA. — To  be  used  as  a  lotion.  Signa. — To  be  used  as  a  lotion. 


NITRATE   OF   POTASSIUM. 


445 


For  Ulceration  and  Inflammation  of  the 
Gums  and  Mucous  Membrane. 

Stocken. 

R .     Potassii  chloratis    , 

Sodii  biboratis    ,    . 

Potasii  nitratis    .    . 

Aquje  deatillatae .   . 


3»j 
3J 


gviij.  M. 


SiGNA. — To  be  used  as  a  gargle. 

For  InflammcUion  of  Gums  and  Mucous 
Membrane. 


For  Inflamed  Gums  and  Mouth. 
R .     Potassii  chlorat  .    .    .    .  3  ij 
PHiIv.  aluminis    .    .    .    .  ^ij 
Aquae destillatae .   .    .    .  ^x.     M. 
SiGXA. — To  be  used  as  a  gargle. 

For  Inflamed  Mucous  Membrane. 
R .     Potassii  chlorat  ....  5  j 
Aluminse  Sulph .    .    .    .   3J 
Aquae  destillatae  .    .    .    .   ^  iv.    M. 
SiGN'A. — To   be   applied  as   a  mouth 
wash. 

For  Periodontitis. 

R.  Potassii  chlorat  .  .  .  .  ^j 
Plumbi  acetas  .  .  .  .  5J 
Aqusefont t^ij.     M. 

SiGX.A- — To  be  used  as  a  month  wash. 

For  Ulceration  of  Gums  and  Mucous 
Membrane  of  Mouth. 
R .     Potassii  chloras  .    .    .    .  3  ij 

Aquae ^  v.     M. 

SiGXA. — A  tablespoonfiil  three  times  a 
day ;  also  as  a  gai^le  four  or  five 
times  a  day. 


POTASSII  NITRAS— NITRATE  OF  POTASSIUM. 


Stocken. 

R. 

Potassii  chloratis    . 

•    .  3ij 

Sodii  biboratis 

•  •  3J 

Potassii  nitratis  .    . 

•    •  35s 

Tinct.  amicae  .   .    . 

•  -3': 

Aquae  rosae     .    .    . 

•    .  |vij. 

M. 

SiGNA. — To  be  used  as  a 

gargle. 

For 

Inflamed  Gums,  Mucous  Membrane, 

etc. 

R. 

Potassii  chlorat  .    . 

•  •  3i 

Sodii  biboratis    .    . 

•    •  3J 

Aquas  destillatae .   . 

•    •  o'J- 

M. 

SiGNA. — To  be  used  as 

a  mouth  ■^ 

•ash 

01 

gargle. 

-SALTPETRE-NITRE. 


Form  ula. — K  N  O , 


Derivation. — Nitrate  of  Potassium  is  obtained  in  the  native 
state  in  various  portions  of  the  world  ;  but  the  variety  em- 
ployed for  medicinal  purposes  is  prepared  by  purifying  the 
native  production  of  India.  It  can  also  be  artificially  made 
by  combining  decayed  organic  animal  and  vegetable  matters, 
or  by  the  double  decomposition  of  nitrate  of  sodium  and 
chloride  of  potassium.  The  crude  nitre  is  refined  by  re-solu- 
tion and  crystallization.  It  is  in  the  form  of  white,  crj'stal- 
line,  six-sided  prisms,  odorless,  with  a  sharp,  saline,  cooling 
and  slightly  bitter  taste,  wholly  soluble  in  water,  but  insolu- 
ble in  alcohol. 

Medical  Properties  and  Action. — Nitrate  of  potassium  is  re- 
frigerant,  sedative,    antiseptic,   diuretic    and   diaphoretic.      It 


446  DENTAL   MEDICINE. 


promotes  the  secretions,  lessens  the  heat  of  the  body  and  the 
frequency;  of  the  pulse.  For  allaying  febrile  excitement  it  is 
frequently  employed  in  the  form  of  nitrous  powders  (nitre, 
gr.  x;  tartar  emetic,  gr.  y%  ;  calomel,  gr.  i^  to  ^). 

In  overdoses,  nitrate  of  potassium  causes  pain  and  heat  in 
the  stomach,  vomiting  and  purging  of  blood,  inflammation  of 
the  bowels,  great  prostration,  convulsions,  and  sometimes 
death. 

The  antidotes  are  emetics,  mucilaginous  and  demulcent 
drinks,  and  stimulants  to  sustain  the  sinking  powers  of  the 
system. 

Therapeutic  Uses. — Nitrate  of  potassium  is  employed  inter- 
nally as  a  refrigerant  in  febrile  affections  ;  in  inflammatory  dis- 
eases, acute  rheumatism,  scurvy,  purpura,  haemoptysis,  passive 
hemorrhages,  asthma,  etc.  In  fevers  it  is  frequently  combined 
with  other  remedies.     The  vapor  is  used  in  spasmodic  asthma. 

Dose. — Of  nitrate  of  potassium,  gr.  ij  to  gr.  x. 

Dental  Uses. — In  dental  practice,  nitrate  of  potassium  has 
been  recommended  in  the  incipient  stages  of  alveolar  abscess 
being  introduced  into  the  pulp  canal  and  secured  by  a  tempo- 
rary filling  in  the  crown  cavity  of  the  tooth.  It  is  also  em- 
ployed in  inflammatory  conditions  of  the  mucous  membrane 
of  the  mouth  and  throat  in  the  form  of  gargles. 

DENTAL  FORMULA. 

For   hifiammation    of   the    Mouth    and       For   Inflamed  Mucous   Memhrane   and 

Throat.  Gums. 

T  iiTT  -<nr  R,     Potassii  Nitratis  .    .    .   Zss 

T.W.White.  ^  ..  .  ^  .. 

Potassii  chloratis  .    >    •  3  ij 
R.     Potassii  nitratis  .    .    .  gijto  ^iv  Sodii  biboratis    .    .    .  3J 

Aquffidestillatse  .    .    .  Oj.  M.  Aquse  destillatae  .    .    .  gviij.     M. 

SiGNA. — To  be  used  as  a  gargle.  SiGNA.— To  be  used  as   an    antiseptic 

and  refrigerant  mouth  wash. 
POTASSII  PERMANGANAS— PERMANGANATE  OF  POTASSIUM. 
Formula. — KgMngOg. 

Derivation. — Permanganate  of  potassium  is  obtained  by  the 
mixture  of  equal  parts  of  black  oxide  of  manganese  and 
chlorate  of  potassium,  with  a  slight  excess  of  caustic  potassa, 
dissolving  in  water,  and  evaporating  to   dryness,  when  it  is 


PERMANGANATE   OF   POTASSIUM.  447 

exposed  to  a  nearly  red  heat;  the  chlorate  of  potassium  yields 
oxygen,  which  changes  the  black  oxide  of  manganese  into 
permanganic  acid,  and  this  acid,  combining  with  the  potassa, 
gives  as  a  product  the  permanganate  of  potassium.  It  is  in  the 
form  of  dark  purple,  slender,  prismatic  crystals,  inodorous, 
very  soluble  in  water,  forming  a  solution  of  a  beautiful  lilac 
color,  even  in  very  minute  proportion,  and  with  a  sweet,  astrin- 
gent taste. 

Medical  Properties  and  Action. — Permanganate  of  potassium, 
when  taken  internally,  is  supposed  to  oxidize  the  blood.  It  is 
a  stimulant,  mild  escharotic,  and  is  a  powerful  disinfectant,  as 
it  has  a  remarkable  power  of  destroying  fetid  odors  from 
organic  sources,  and  proves  useful  in  preventing  the  spread  of 
infectious  disease.  It  yields  up  its  oxygen  readily,  in  the  form 
of  ozone,  and  its  use  depends  upon  this  property.  It  is  in- 
stantly decomposed  on  reaching  the  stomach. 

Therapeutic  Uses. — Permanganate  of  potassium  is  employed 
with  advantage  in  dyspepsia,  flatulence,  excessive  deposition 
of  fat,  uric  acid  diathesis,  acute  rheumatism,  diabetes,  scarla- 
tina, petechial  fever,  spinal  meningitis.  Condy's  Fluid  is  a 
favorite  preparation  with  some,  for  both  internal  and  external 
use.  The  most  important  uses  for  permanganate  of  potassium 
are  externally,  as  a  deodorizer  and  disinfectant,  to  correct  the 
fetor  of  cancer,  abscesses,  ulcers,  caries  of  bone,  ozaena,  otor- 
rhoea,  gonorrhoea,  leucorrhoea,  ulcerated  sore  throat,  etc.,  in 
the  form  of  injections,  lotions  and  spray.  It  is  also  used 
externally  in  the  treatment  of  diphtheria,  in  the  proportion  of 
a  drachm  of  Condy's  Fluid  to  the  ounce  of  water.  In  solution, 
permanganate  of  potassium  is  applied  m  varying  strength, 
according  to  the  effect  desired.  As  a  local  stimulant,  as  well 
as  deodorizer,  it  is  useful  in  chronic  and  indolent  ulcers,  car- 
buncles, hospital  gangrene,  etc.  The  powder  may  be  sprinkled 
on  gangrenous  surfaces.  In  concentrated  solution  permanga- 
nate of  pota.ssium  acts  as  a  caustic.  A  strong  solution  is 
composed  of  lo  parts  dissolved  in  90  parts  of  water,  and  is 
employed  in  its  full  strength  in  cancerous,  phagedenic  and 
atomic  ulcers.    For  dressing  simple  wounds,  or  as  an  injection 


448  DENTAL   MEDICINE. 


in  abscesses,  oz^na,  leucorrhoea,  etc.,  half  a  fluid  ounce  of  the 
solution  may  be  added  to  a  pint  of  water  ;  in  gangrenous  and 
dipththeritic  wounds  and  scrofulous  ulcers,  a  fluid  ounce  of 
the  solution  to  a  pint  of  water. 

Dose. — Of  permanganate  of  potassium  for  internal  use,  gr. 
y^  to  gr.  j,  three  times  a  day.  Cond/s  Fluid  is  composed  of 
32  grains  of  permanganate  of  potassium  in  one  pint  of  dis- 
tilled water ;  half  a  fluid  ounce  contains  one  grain.  Dose  of 
Condy's  Fluid,  TTLv.  For  external  application,  foj,  to  water, 
fov  to  X.  Solution  of  permanganate  of  potassium — Liquor 
Potassii  Permanganatis ,  is  composed  of  64  grains  of  perman- 
ganate of  potassium  to  one  pint  of  distilled  water.  M.  de 
Lacerda  has  recently  discovered  that  permanganate  of  potas- 
sium is  one  of  the  most  energetic  antidotes  to  the  venom  of 
snakes. 

Dental  Uses. — In  dental  practice  the  permanganate  of  po- 
tassium is  employed  in  the  treatment  of  fetid  and  gangrenous 
ulcerations  of  the  mouth,  such  as  cancrum  oris,  foul  abscesses, 
ulcerations  of  mucous  membrane  attended  with  fetid  discharges, 
offensive  breath;  as  an  antiseptic  for  decomposing  pulps  of 
teeth  (grs.  ij  to  water  Sj) ;  in  diseases  of  the  antrum,  such  as 
abscess,  and  caries  and  necrosis  of  the  maxillary  bones,  Riggs' 
disease,  ulcers  of  the  mouth,  pyorrhoea  alveolaris,  etc.  (grs.  x 
to  water  oj).  The  powdered  crystals  introduced  into  a  carious 
cavity  will  relieve  odontalgia.  The  stains  of  permanganate  of 
potassium  can  be  removed  by  dilute  hydrochloric  acid. 

DENTAL  FORMULA. 

For  Unhealthy  Ulcers  of  the  Mouth,  avd  For  Fetid  Perspiration  and  Foul  Breath. 

Offensive  Breath.  j^  _     Potassii  permanganatis  .  gr.  j 

J.  W.  White.  Aquae  destillatse   .    .    .  f,^j.      M. 

R .     Potas.  permanganatis  .  Qj  to  iv  SiGNA. — To  be   used  as  a  lotion  and 

Aquas  destillatse  .    .      Oj.         M.  gargle. 
SiGNA. — To  be  used  as  a  gargle. 

For  Gangrenous  Ulceration  of  the  Mouth  ^or  a  Disinfectant  in  Mercurial  Saliva- 

—  Cancrum  Oris.  tion. 

R .     Potassii  permanganatis  .  gr.  xxx  R  •     Potassii  permanganatis  gr.  xv 

Aqua  destiUatffi    .    .    .  ^j.       M.  Aqu^  destillatse  .  .    .  f  gviij.     M. 

SiGNA. — Apply  as  a  lotion.  SiGNA. — Use  as  a  gargle 


PYOKTANIN.  449 


For   Ulcers,  Abscesses,  Decomposing  Pulps  of  Teeth,  etc. 

R.     Liquoris  potassii  permanganatis ^j 

Aquj^  destillatae §  vj  to  x.  M. 

Sigma. — To  be  used  as  a  gargle  or  as  an  injection. 

PRUNUS  VIRGINIANA— WILD  CHERRY. 

Source. — Prunus  Virginiana  is  obtained  from  the  bark  of 
the  Prunus  Serotina,  and  is  composed  of  amygdalin  an  emul- 
sion, from  which,  by  their  reaction,  tannic,  galHc  and  hydro- 
cyanic acids  are  produced.  The  preparations  of  wild  cherry 
are:  Infusiim  Pnini  VirginiancB — Infusion  of  wild  cherry;  Ex- 
tractum  Pruni  Virginiatice  Fluidum — Fluid  extract  of  wild 
cherry;  Syrupiis  Pruni  VirginiancE — Syrup  of  wild  cherry. 

Medical  Properties  and  Therapeutic  Uses. — Wild  cherry  is  an 
aromatic  bitter  stomachic,  tonic  and  expectorant.  It  is  em- 
ployed as  a  stomachic,  tonic  and  in  catarrhal  conditions  of  the 
bronchial  mucous  membrane,  phthisis,  etc.  The  syrup  forms 
one  of  the  ingredients  of  many  cough  mixtures. 

Dose. — Of  tincture  of  wild  cherry,  5ss  to  5ij;  fluid  extract, 
5ss  to  5ij ;  infusion,  5ss  to  5j. 

PYOKTANIN— METHYL- VIOLET. 

Derivation. — Pyoktanin  is  only  a  name  applied  to  the  well 
known  aniline  color  methyl-violet,  an  aniline  dye,  which  is  in 
the  form  of  a  paste  and  in  crystals. 

It  is  without  color,  but  slightly  irritant,  and  non-intoxicating. 
It  has  been  employed  in  the  form  of  powder,  solution  and 
pencil.  The  powder  is  made  by  mixing  2  parts  of  pyoktanin 
or  methyl-violet  with  lOO  parts  of  talc  or  other  inert  substance. 
The  solution  is  of  any  strength  from  i  part  in  lOOto  i  in  20CX). 
Pyoktanin  is  also  used  in  the  form  of  ointment  containing  from 
2  to  10  per  cent.  There  is  also  another  aniline  color — the 
yellow —  to  which  the  same  name  has  been  given ;  but  the 
violet  is  the  stronger. 

Medical  Properties  afid  Therapeutic  Uses. — Pyoktanin  is  con- 
sidered by  many  to  be  an  efficient  germicide.  According  to 
Fessler,  the  micro-organisms  of  pus  are  destroyed  by  it  in  fif- 
teen minutes  when  the  solution  is  of  the  strength  of  i  to  looo. 
29 


450  DENTAL  MEDICINE. 


This  action  is,  however,  denied  by  Troje,  who  considers  pyok- 
tanin  to  be 'less  powerful  than  bichloride  of  mercury,  or  even 
carbolic  acid.  It  does  not  coagulate  albumen,  and  when  applied 
to  the  eye  causes  dilatation  of  the  pupil  without  paralysis  of 
accommodation.  Pyoktanin  is  employed  topically  to  disinfect 
suppurating  or  ulcerated  wounds,  to  stimulate  chronic  ulcers. 
As  an  application  to  open  buboes,  boils,  carbuncles,  chancroids, 
etc.;  also  in  the  form  of  weak  solution  in  gonorrhoea,  and 
chronic  cystitis.  And  as  a  dusting  powder  in  moist  eczema, 
and  also  in  other  affections  of  the  eye,  the  ear,  nose  and  throat. 

It  has  no  odor,  and  in  this  respect  is  preferable  to  iodoform, 
but  it  stains  the  skin ;  the  discoloration  may  be  removed  by 
cologne  water,  alcohol,  dilute  hydrochloric  or  nitric  acids. 

Dental  Uses. — Pyoktanin  is  employed  in  dental  practice  in 
all  cases  where  ordinary  antiseptics  are  indicated,  as  in  gan- 
grenous pulps,  root-canals,  disinfecting  cavities  before  filling, 
alveolar  abscess,  etc. 

PYRETHRUM— PELLITORY. 

Source — Pyrethrum  is  a  native  of  the  Mediterranean  coast, 
and  the  root  is  the  medicinal  portion — pyrethri  radix,  in 
the  form  of  cylindrical,  wrinkled  pieces,  of  the  size  of  the  little 
finger,  hard  and  brittle,  which,  when  dried,  has  little  or  no  odor. 
Externally,  it  is  of  an  ash-brown  color,  within  white,  and  pos- 
sesses an  extremely  acrid  taste,  with  a  burning  and  tingling 
sensation  over  the  whole  mouth  and  throat,  which  continues 
for  some  time,  and  excites  a  copious  flow  of  saliva. 

Medical  Properties  and  Action — Pyrethrum  root  is  an  irritant 
and  sialagogue,  and  when  it  is  rubbed  on  the  skin  it  causes 
much  irritation,  and  may  even  excite  inflammation. 

Its  activity  depends  upon  an  acrid  oil  and  a  compound  resin 
called  pyrethrin.  It  is  rarely  used  internally,  and  only  as  a 
masticatory. 

Therapeutic  Uses. — Pyrethrum  has  been  employed  as  an 
excitant  in  paralysis  of  the  tongue  and  muscles  of  the  throat, 
relaxed  sore  throat,  spontaneous  salivation,  certain  forms  of 


WHITE   OAK   BARK.  451 


headache;  for  such  purposes  being  chewed,  or  employed  in  the 
form  of  a  gargle,  in  tincture  or  decoction. 

Dose. — Of  pyrethrum  as  a  masticatory,  gr.  xv  to  5j.  Tinc- 
tura  Pyrctliri,  Tincture  Pyrethrum,  is  composed  of  py- 
rethrum Siv,  rectified  spirit  Oj. 

Dental  Uses. — Pyrethrum  is  employed  in  dental  practice  for 
neuralgic  affections  of  the  face,  for  which  it  is  chewed  ;  for  the 
relief  of  odontalgia,  in  the  form  of  the  tincture  applied  to  the 
irritable  pulp  on  a  pellet  of  cotton  ;  as  a  stimulant  to  the  gums 
and  mucous  membrane  of  the  mouth  in  relaxed  conditions  ; 
for  obtunding  sensitive  dentine,  in  the  form  of  a  strong  alco- 
holic extract.  The  ethereal  oil  of  pyreilinmi  is  recommended 
as  a  pleasant  and  efficacious  remedy  in  odontalgia,  applied  in 
the  same  manner  as  the  tincture ;  the  fluid  extract  is  also 
employed  as  an  ingredient  for  local  anaesthetic  preparations, 
combined  with  chloroform,  ether  and  lavender,  (See  Chlo- 
roform.) 

DENTAL    FORMULA. 
For  Relaxed  Conditions  of  Mucous  Atembrane  of  Mouth  and  Gums. 

R .     Tinctura  pyrethri f  3  "j 

Aquae §  viij.         M, 

SiGNA. — To  be  used  as  a  stimulant  gargle. 

QUERCUS  ALBA— WHITE  OAK. 

Source. — White  oak,  the  dried  inner  bark  of  which  is  the 
medicinal  portion,  is  a  common  tree  of  the  natural  order 
Amentacecc.  The  bark  has  a  light-brown  color,  fibrous  texture 
and  an  astringent,  bitter  taste.  Its  medicinal  virtues  depend 
upon  the  presence  of  tannic  and  gallic  acids,  and  a  bitter 
principle  known  as  quercin.  Water  and  alcohol  form  with  it 
decotions  and  tinctures. 

Medical  Properties  and  Action. — White  oak  bark  is  tonic, 
astringent  and  antipcriodic.  It  is  principally  used  as  an 
external  application. 

Therapeutic  Uses. — White  oak  bark  is  employed  internally 
in  the  treatment  of  diarrhoea,  dysentery  and  hemorrhoids. 
Externally  in  relaxation  of  the  uvula,  tonsils,  etc. ;  gangrene, 
indolent  ulcers,  leucorrhoea,  atonic  menorrhagia,  fissure  of  the 


452  DENTAL   MEDICINE. 


anus,  etc.,  etc.,  in  the  form  of  tincture,  decoction,  gargles, 
lotions  and  injections. 

Decoction  of  White  Oak  Bark,  Decoctum  Quercus  Albce, 
is  composed  of  oak  bark,  Sj ;  water,  Oj. 

Dose. — Of  powdered  white  oak  bark,  gr.  xxx  to  gr.  xl.  Of 
the  decoction  the  dose  is  fSss  to  f  §j. 

Dental  Uses. — In  dental  practice  the  decoction  and  tincture 
are  employed  externally  in  the  various  forms  of  stomatitis, 
sponginess  of  the  gums,  and  relaxed  condition  of  the  mucous 
membrane  of  the  mouth  and  fauces. 

QUILLAYA  SAPONARIA— QUILLAIA  BARK. 
SOUTH    AMERICAN   SOAP    TREE    BARK. 

Source — Quillaia  Bark  is  obtained  from  an  evergreen  tree 
of  the  natural  order  Rosace (B — rose  order,  growing  in  Chili 
and  Peru,  the  inner  bark  being  employed. 

Medical  Properties  and  Action.  Quillaia  bark,  when  bruised 
and  macerated  in  water,  imparts  to  that  liquid  the  property  of 
frothing  like  soap  solution  when  agitated,  which  is  owing  to 
the  saponaria  in  the  bark,  the  same  principle  which  imparts  a 
similar  property  to  soapwort — saponaria  officinalis.  Quillaia 
contains  no  tannic  acid  or  other  bitter  principle,  and  is  an 
article  of  commerce,  being  imported  in  large  quantities  for 
cleansing  grease  from  cloth,  as  it  does  not  change  the  color  of 
silken  or  woolen  goods ;  it  is  also  used  for  cleansing  the  hair, 
which  it  is  supposed  to  preserve  and  beautify.  When  the 
powder  is  snuffed  up  the  nostrils,  it  causes  sneezing  and  a 
profuse  nasal  discharge. 

Therapeutic  Uses. — Quillaia  bark  has  been  employed  as  a 
febrifuge,  to  arrest  excessive  secretion,  as  an  application  to 
ulcers,  as  a  remedy  for  colds  in  the  head,  when  it  is  used  as  a 
sternutatory,  in  the  form  of  powder. 

The  tincture  is  composed  of  quillaia  bark  i  part ;  alcohol  5 
parts ;  it  is  also  used  in  the  form  of  infusion  and  fluid  extract. 

Dental  Uses — Quillaia  bark,  in  the  form  of  powder,  tincture 
and  fluid  extract,  is  employed  as  an  ingredient  of  mouth- 
washes, for  its  frothy  and  detergent  properties  ;  it  is  also  used 


SULPHATE  OF  QUININE.  453 

as  an  application  to  chronic  ulcers  of  the  mouth,  and  to  ar- 
rest excessive  secretion  of  the  mucous  membrane  of  the  mouth. 

DENTAL    FORMULAE. 

Detergent  Mouth   Wash.  For  a  Mouth    Wash. 

Am.  Journ.  Pharm.  R  .     Pulv.  quillaiae  sapona- 

R     Pulv.      potassii      bicar-  "se |  iv 

bonatis 3  ss  Glycerini 5  iij 

Mellis 5iv  Alcoholis  dilutus  suf- 

Alcoholis 5  ij  ficient  for  2  pints. 

Olei  caryophylli  .    .    .  q.s.  Olei  gaultheriie  .    ,    .  gtt.xx. 
Olei  gaultherise,  Olei  menthje  ....  gtt.xx.      M. 
Quillaise         saponariM  ^  Macerate  the  soap  bark  in  the  rnix- 
(nuid  ext.)  .  .  aa  .  .    5J  ture  of  glycerine  and  alcohol  for  three 
Aquae  destillatje    .    .    .   5ix.  M.       ^^^^^  ^nd  filter  through  a   little  mag- 
To  be  used  after  the  removal  of  sali-       nesia  previously  tritiu-ated  with  the  vol- 
vary  calculus.  atile  oils. 

For  Inflamed  Gums  and  Mucous  Membrane. 
Chapin  a.  Harris. 

R .     Quillaia;  saponarioe 5  viij 

PjTethri, 
Radicis  iridis, 
Acidi  beruoici, 

Cinnamom aa 5J 

Acidi  tannici ^  iv 

Sodii  boratis 'J^iv 

Olei  gaultheriae f  5  ij 

Olei  menthae f  3  iv 

Cochineal ^  iij 

Sacchari  albi Ibj 

Alcoholis Oiij 

Aqua  purse      0\\     M. 

Digest  for  six  days  and  filter. 

Signa. — To  be  used  as  a  gargle  or  mouth  wash. 

QUININ/E   SULPHAS— SULPHATE  OF    QUININE. 

Formula.— Z^^^fi^,  3H2O. 

Derivation. — The  two  important  alkaloid  principles  of  cin- 
chona are  qninia  and  cincJionia,  which  exists  in  combination 
with  kinic  acid.     (See  Cinchona.) 

Sulphate  of  Quinine  is  obtained  by  boiling  the  powdered 
yellow  cinchona  bark  in  water  acidulated  with  hydrochloric 


454  DENTAL   MEDICINE. 


acid,  by  which  the  alkaloid  quinine  is  separated  from  kinic 
and  other  acids,  and  forms  a  soluble  hydrochlprate  or  muri- 
ate, the  salt  being  decomposed  and  the  quinine  precipitated 
by  the  addition  of  lime ;  sulphuric  acid  is  added,  after  diges- 
tion in  boiling  alcohol,  which  dissolves  the  quinine,  and  the 
solution  is  boiled  with  animal  charcoal,  filtered  and  allowed 
to  crystallize.  Sulphate  of  quinine  is  in  the  form  of  color- 
less, very  light  and  silky  crystals,  which  are  readily  soluble  in 
alcohol  and  in  water  acidulated  with  sulphuric  acid,  but  in- 
soluble in  ether.  It  has  an  intensely  bitter  taste,  and  is  in- 
odorous. 

Medical  Properties  and  Actio?i. — Sulphate  of  quinine  is  a 
very  valuable  tonic  and  antiperiodic,  also  antiseptic  and 
stimulant.  In  small  doses  it  increases  the  fullness  of  the  pulse 
and  action  of  the  heart,  and  improves  the  tonicity  of  the  cap- 
illary vessels,  and  is  diffused  into  various  parts  of  the  sys- 
tem with  great  rapidity.  In  large  doses  it  depresses  the  ac- 
tion of  the  heart,  lowers  the  blood  pressure,  and  enfeebles  as 
well  as  diminishes  the  beats  of  the  pulse.  As  it  accumulates 
in  the  brain,  it  causes  a  fullness  in  the  head,  a  constricted 
feeling  about  the  forehead,  a  buzzing  or  ringing  in  the  ears — 
tinnitus  mirium,  giddiness,  vertigo  and  deafness,  which  may 
be  permanent  if  the  agent  is  taken  in  excessive  quantity ;  also 
amaurosis  and  amblyopia  may  be  caused  by  full  doses. 
Poisonous  doses  cause  intense  headache,  dilated  pupils,  de- 
lirium, coma  and  convulsions.  Some  five  hours  are  required 
to  bring  about  the  greatest  effect  of  quinine,  although  it  can 
be  detected  in  the  urine  in  about  half  an  hour  after  it  is  taken 
into  the  stomach,  and  elimination,  chiefly  by  the  kidneys,  is 
not  completed  in  a  less  time  than  48  hours,  although  the 
principal  portion  is  excreted  in  12  hours. 

Therapeutic  Uses. — Quinine  is  extensively  employed  in 
periodical  diseases  of  a  malarial  origin,  such  as  intermittent 
fever,  neuralgia  of  various  forms,  as  enteralgia,  hepatalgia, 
nephralgia,  gastralgia,  sciatica,  angina  pectoris,  and  in  cases 
of  debility,  pneumonia,  pleurisy,  endocarditis,  pyaemia,  erysipe- 
las, puerperal  fever,  cerebro-spinal  meningitis,  eruptive  fevers, 


HYPOPHOSPHITE   OF   QUININE.  455 

etc.,  etc.,  but  the  most  important  use  of  quinia  is  for  the 
treatment  of  malarial  diseases. 

Dose. — Of  sulphate  of  quinine,  gr.  j  to  3j,  in  aromatic 
water,  by  the  aid  of  aromatic  sulphuric  acid,  and  also  as  an 
enema,  or  hypodermically.  Pills  may  be  made  by  combining 
24  grains  of  sulphate  of  quinine  with  14  grains  of  clarified 
honey,  and  dividing  into  24  pills.  Pills  can  also  be  made  with 
glycerine. 

Dental  Uses. — Sulphate  of  quinine  is  internally  employed  in 
dental  practice  in  reducing  inflammation  of  the  peridental 
membrane  when  resorted  to  in  the  early  stages  of  the  disease, 
and  before  effusion  of  inflammatory  products,  cell-proliferation 
and  escape  of  the  white  blood  corpuscles  have  occurred ;  also 
in  hypersensitiveness  of  dentine — three  or  four  grain  doses 
every  four  hours  until  thirty  grains  have  been  taken  (Klump). 
The  treatment  of  facial  and  other  neuralgic  affections,  espe- 
cially when  of  malarial  origin,  in  cancrum  oris,  for  its  tonic 
and  stimulant  effects,  in  aphthous  ulcerations  of  the  mouth 
and  in  scurvy,  where  the  system  is  much  debilitated,  and 
externally  as  an  ingredient  of  dentifrices,  for  its  tonic  and 
stimulating  properties. 

QUININE  HYPOPHOSPHIS HYPOPHOSPHITE  OF  QUININE. 

Derivation. — Hypophosphite  of  Quinine  is  obtained  by  dis- 
solving quinine  with  hypophosphorous  acid,  or  by  decompos- 
ing sulphate  of  quinine  with  hypophosphite  of  baryta,  filtering 
and  evaporating  the  solution. 

Medical  Properties  a7id  Action. — Same  as  those  of  sulphate 
of  quinine,  but  not  so  powerful  in  its  action. 

Therapeutic  Uses. — Hypophosphite  of  quinine  is  used  in  all 
cases  where  hypophosphites  are  indicated,  and  its  action  is 
milder,  on  account  of  its  containing  less  acid.  It  is  employed 
as  an  antiperiodic,  and  is  especially  adapted  for  the  treatment 
of  children  during  the  period  of  dentition  when  it  is  accom- 
panied with  emaciation,  loss  of  appetite  and  strength,  and  when 
convulsions  are  threatened. 


456  DENTAL   MEDICINE. 


Dose. — Of  hypophosphite  of  quinine,  gr.  j  to  gr.  iij. 

DENTAL   FORMULA. 
For  Facial  Neuralgia  from  Dental  For  Neuralgia  from  Dental  Disturb- 

Disturbance.  ance. 

Barrett  ^*  ^^  ■*-"■  Gorgas. 

R .     Quininse  sulphatis  .    .  gr.x 
Ferri  sulphat.  exsic  .  .  gr.v 
Acidi  arseniosi    .    .    .  gr.ss 
Ext.  nucis  vomicse     .  gr.v.        M. 
Ft.  pil.  No.  XX. 
SiGNA. — One  pill  every  four  hours. 


R .     Ferri  at  quin  (cit)  .    .  ^  ij 
Syrup  aurantii  ■    .    •  ^  j 

Aqua  dest f^'] 

Elixir  calisayse     .    .  ^ij  M. 

SiGNA. — Coch.  parv.  ter  in  die. 


For  Neuralgia  Associated  with  por  Acute  Periodontitis, 

^'^'^^i'^-  R.     Quinina;  sulph    .    .    .   ^ss 

Garretson.  Acidi  sulph.  aromat.  .  gij 

Bt .     Tinct.  ferri  chloridi  .    .  §  j  Elix.  calisaya  bark  .    .  3  xiv.    M. 

Quininse  sulphatis  .  .    .  ^j      M.  SiGNA. — A   teaspoonful    every  two    or 

Signa. — Teaspoonful  four  times  daily.  three  hours. 

RESORCIN. 

Derivation. — Resorcin  is  a  chemical  compound  of  the  phenol 
group  and  aromatic  series,  to  which  carbolic  acid  belongs.  It 
is  obtained  from  certain  resins  by  the  action  of  fusing  alkalies, 
and  is  of  the  form  of  tabular,  prismatic,  shining  crystals  some- 
what sweetish  to  the  taste,  followed  by  a  slight  pungency. 
Resorcin  is  very  soluble  in  water,  95  parts  in  100,  and  to  a 
less  degree  in  alcohol,  ether,  glycerine  and  vaseline ;  chloro- 
form and  carbon  sulphide  will  not  dissolve  it.  It  darkens  on 
exposure  to  the  air,  and  is  phosphorescent  when  rubbed  in 
the  dark.  Its  odor  is  somewhat  similar  to  that  of  phenol,  but 
not  so  strong. 

Medical  Properties  and  Uses. — Resorcin  acts  somewhat  simi- 
lar to  quinine,  although  it  differs  from  the  latter  in  its  lethal 
effects.  Quinine,  carbolic  acid  and  salicylic  acid  promote  its 
effects ;  atropine  antagonizes  it.  Through  its  action  on  the 
nervous  system,  it  greatly  increases  in  frequency  the  respira- 
tion, which  becomes  convulsive  and  spasmodic,  and  afterward 
weak  but  rapid.  It  also  increases  the  action  of  the  heart, 
causes  the  pulse  to  become  weak  and  irregular.  It  is  eliminated 
by  the  urine  quite  rapidly.  It  has  no  irritating  action  on 
mucous  membranes. 


RESORCIN. 


457 


Therapeutic  Uses. — Resorcin,  on  account  of  its  less  irritating 
property  is  considered  preferable  to  carbolic  acid  for  internal 
use  and  subcutaneous  injection.  It  is  employed  internally  in 
catarrh  of  the  stomach,  ulceration,  gastralgia,  fermentative  in- 
digestion, fevers,  for  its  antiseptic  and  antipyretic  actions,  and 
ulcerative  endocarditis,  etc.,  etc.  Locally  on  account  of  its 
antiseptic  properties,  in  diphtheria,  in  syphilitic  and  other 
sloughing  sores,  and  anthrax,  in  the  form  of  crystals  or 
powder,  and  in  the  form  of  spray  in  catarrhal  and  ulcerating 
affections  of  the  nose  and  throat ;  in  solution,  on  account  of 
its  antiseptic  action,  it  is  used  for  dressing  putrid  and  atonic 
wounds,  and  is  combined  with  water,  glycerine  and  alcohol  ; 
it  is  also  used  in  pomades. 

A  compound  composed  of  resorcin  and  salicylic  acid  heated 
together,  is  known  as  "Salicyl  Resorcin-Ketone,"  and  is  anti- 
septic to  a  degree,  as  it  limits  the  development  of,  rather  than 
destroys,  septic  germs.  It  is  soluble  in  glycerin  and  alcohol, 
and  is  neither  poisonous  nor  disagreeable  to  the  taste. 

Dose. — Of  resorcin,  gr.  v-xv.  Five  grains  every  two  hours 
in  an  ordinary  case. 

Dental  Uses. — Resorcin  is  a  valuable  antiseptic  in  dental 
practice,  and  may  be  applied  with  advantage  in  all  cases  where 
antiseptics  are  indicated.  A  ten  per  cent,  solution  of  resorcin 
is  recommended  in  cases  of  chronic  alveolar  pyorrhoea  (after 
cleansing  the  pockets  with  peroxide  of  hydrogen)  where  there 
is  impaired  circulation  of  the  tissues.  (See  Antiseptic  Uses  of 
Carbolic  Acid.) 

DENTAL    FORMULAE. 

For  Alveolar  Pyorrhma. 

Dr.  a.  W.  Harlan. 


For  Alveolar  Pyorrhoea. 
Dr.  a.  W.  Harlan. 

R.     Resorcin gij 

Acidi  carbolici     .    .    •  ,^j 

Glycerini ^^  iij 

Aquae  ,  q.s       ....  ^viij.    M. 
SiGNA. — Use   as  mouth-wash  after  re- 
moving all  deposits,  and  the  adjacent 
carious  or  necrosed  bone. 

A  few  drops  of  oil  of  peppermint 
or  any  other  desirable  oil  may  be 
added  to  the  above. 


R. 


Resorcin  .    . 
Acidi  tannici 
Olei  cassia  . 
Glycerini 
Aquffi  dest  . 


gr.  XXX 

gr.  V 


SiGNA. — Inject  with  a  syringe  into  the 
remains  of  the  pockets  in  the  after 
treatment. 


458  DENTAL   MEDICINE. 


For  Mucous  Patches  of  the  Mouth. 
Dr.  a.  W.  Harlan. 

R .     Resorcin gr.  xl 

Aquae  dest ^  ss.      M. 

SiGNA. — Dry  surface  and  paint  with  above. 

RHEUM— RHUBARB. 

Source. — The  root  of  Rheum  officinale.  It  contains  two  acids> 
rheo-tannic  and  rheumic,  a  resin,  phcEoretin  and  an  acid,  chryso- 
phan  or  chrysophani. 

Medical  Properties  and  Therapeutic  Uses. — Rhubarb  possesses 
tonic  and  astringent  as  well  as  purgative  properties.  In  small 
doses,  as  a  tonic,  it  promotes  the  appetite  and  digestive  power, 
and  by  virtue  of  the  tannic  acid  it  contains,  is  astringent.  The 
purgative  principle  it  possesses  enables  sufficient  doses  of 
rhubarb  to  act  as  a  cathartic,  producing  stools  which  are  of  a 
yellowish  brown  color,  and  soft  but  not  watery.  It  has  no  ten- 
dency to  cause  gastro-enteric  inflammation.  It  is  now  classed 
among  the  cholagogues,  as  it  increases  the  flow  of  bile  and 
the  intestinal  secretions,  which  is  due  to  phseoretin — rhubarb 
resin.  Its  coloring  matter  not  only  stains  the  stools,  but  also 
the  perspiration,  milk  of  nursing  women,  to  which  it  gives  a 
bitter  taste  and  purgative  principles,  and  the  urine.  It  is  em- 
ployed with  benefit  in  diarrhoea  caused  by  the  accumulation  of 
undigested  food  in  the  intestines,  hemorrhoids  accompanied 
by  constipation,  dyspepsia  with  deficient  biliary  and  intestinal 
secretions,  the  summer  diarrhoea  of  children  in  the  form  of  the 
aromatic  syrup  and  in  catarrh  of  biliary  ducts  with  jaundice ; 
and  the  chewing  of  rhubarb-root  is  beneficial  in  habitual  con- 
stipation; its  frequent  use,  however,  is  objectionable  on  account 
of  the  astringent  after-effect,  which  in  the  rhubarb  pill  is 
remedied  by  the  soap. 

Dose. — Of  Extractum  Rhei — Extract  of  Rhubarb,  grs.  x  to 
grs.  XV.  Of  Extractu7n  Rhei  Fluidum — Fluid  extract  of  rhu- 
barb, 5ss  to  5ij.  Of  PilulcB  Rhei — Rhubarb  pills,  each  pill  con- 
sists of  grs.  iij  of  rhubarb  and  gr.  j  of  soap.  Of  Pilules  Rhei 
Composites — Compound  pills  of  rhubarb,  consisting  of  rhubarb, 


PHEXYLIC   ETHER   OF   SALICYLIC  ACID.  459 

aloes  and  myrrh.  Dose,  2  to  four  pills.  Of  Syrupus  Rliei — 
Syrup  of  rhubarb,  5ss  to  5ij-  Of  Tinctiira  Rhei  Aromaticus — 
Aromatic  tincture  of  rhubarb,  5ss  to  5ij.  Of  Tinctura  Rhei 
Dulcis — Sweet  tincture  of  rhubarb,  oss  to  §ij.  Of  Vimivi 
Rhei — Wine  of  rhubarb,  3j  to  oss.  Oi  Piilvis  Rhei  Compositiis 
— Compound  powder  of  rhubarb,  a  teaspoonful. 

RHIGOLENE. 

Derivation. — Rhigolene  is  a  product  of  the  distillation  of 
petroleum.  In  its  composition  it  is  a  hydrocarbon,  and  is 
destitute  of  oxygen,  being  extremely  volatile  and  inflammable, 
and  is  the  lightest  of  all  liquids,  with  a  specific  gravity  of 
0.625.  It  is  a  petroleum  naphtha,  and  boils  at  70°  F.,  and 
when  perfectly  pure  should  be  almost  odorless ;  but  it  is 
difficult  to  procure  any  specimen  that  does  not  have  the  un- 
pleasant odor  of  petroleum.  It  is  colorless,  and  on  account 
of  its  great  volatility  and  inflammability  requires  to  be  kept 
tightly  stoppered,  in  a  cool  place.  The  storage  of  large  quanti- 
ties, except  in  very  secure  places,  is  attended  with  considerable 
risk,  and  on  this  account  it  is  somewhat  difficult  to  procure  it 
outside  of  the  manufactories.  It  is  dangerous  to  use  it  at 
night,  or  near  a  light. 

Dental  Uses. — Rhigolene  is  employed,  like  absolute  ether, 
to  produce  local  anaesthesia,  by  dispersing  it  in  the  form  of 
spray,  with  the  spray  apparatus,  being  the  most  rapid  in  its 
congealing  effects,  and  also  the  most  easily  controlled  and  con- 
venient of  all  of  the  freezing  mixtures.  As  a  local  anaesthetic 
it  is  employed  in  the  operation  of  extracting  teeth,  by  apply- 
ing it,  in  the  form  of  spray,  to  the  parts  about  the  tooth  to  be 
removed  until  a  blanched  surface  of  gum  is  produced.  The 
spray  of  rhigolene  is  also  applied  to  the  gum  over  the  root  of 
a  tooth  affected  with  incipient  periodontitis. 

SALOL— PHENYLIC  ETHER  OF  SALICYLIC  ACID. 

Derivation. — Salol  is  obtained  by  the  combination  of  salicylic 
acid  and  phenol,  consisting  of  60  parts  of  weight  of  salicylic 
acid  and  forty  parts  of  phenol.    It  is  a  white,  crystalline  powder, 


460  DENTAL   MEDICINE. 


insoluble  in  water,  without  odor  and  nearly  tasteless.  In  the 
system  it  becomes  decomposed,  yielding  salicylic  and  carbolic 
acids  in  nascent  forms. 

Medical  Properties  and  Therapeutic  Uses. — Salol  is  antiseptic, 
germicide  and  antipyretic,  and  possesses  less  poisonous  proper- 
ties than  either  salicylic  acid  or  carbolic  acid  alone ;  large 
doses  of  salol,  however,  cannot  be  administered  without  danger 
of  phenol  poisoning.  It  is  accumulative,  owing  to  its  being 
absorbed  and  eliminated  slowly,  and  hence  cannot  be  given  too 
frequently. 

In  acute  and  chronic  renal  diseases,  salol  is  contra-indicated. 
It  is  employed  internally  in  disorders  of  stomach,  acute  gastro- 
enteritis, tonsillitis,  gonorrhoea,  skin  diseases,  gleet,  etc.  Ex- 
ternally used,  salol  is  an  excellent  dressing  for  wounds,  ulcers, 
burns,  erysipelas  and  skin  diseases.  Camphorated  salol  is 
highly  recommended  by  Cuirllier  in  the  treatment  of  otitis. 
It  can  be  mixed  with  iodoform  or  iodol,  and  the  action  of  both 
be  had  simultaneously. 

Dose. — Gr.  v  to  5j. 

For  Erythema. 
Dr.  a.  Eichler. 

R.     Saloli 3ij 

Zinci  oxidi ,•    •    ■ 

Pulv.  amyli aa  3  iv 

Lanoline .    .    .  5J.  M. 

SANDARACA— SANDARACH. 

Source. — Sandarach  is  a  resinous  substance  obtained  from 
an  evergreen  tree — Thuya  Articulata — which  grows  in  the 
northern  part  of  Africa.  The  gum  is  in  the  form  of  small, 
irregular,  round  and  oblong  tears,  of  a  pale  yellow  color,  some- 
times brown,  and  more  or  less  transparent,  dry  and  brittle.  It 
has  a  faint,  agreeable  odor,  which  is  increased  by  warmth,  and 
a  resinous,  somewhat  acrid  taste.  It  melts  with  heat,  diffusing 
a  strong  balsam  odor,  and  is  inflammable.  It  is  soluble  in 
alcohol  and  ether,  and  slowly  dissolves  in  warm  oil  of  turpen- 
tine. It  consists  of  three  resins,  varying  in  their  relations  to 
alcohol,  ether  and  oil  of  turpentine.     The  sandaracin  which 


SERPENTARIA.  461 


remains  after  sandarach  has  been  exposed  to  the  action  of 
ordinar}^  alcohol  is  a  mixture  of  two  of  these  resins. 

Uses. — Sandarach  was  formerly  employed  as  a  medicinal 
agent,  and  entered  into  the  composition  of  various  ointments 
and  plasters,  but  its  use  is  now  restricted  to  such  purposes  as 
the  composition  of  a  varnish,  ingredient  of  incense,  etc.  After 
the  erasion  of  ink  marks,  its  powder,  if  rubbed  on  such  a  sur- 
face, will  prevent  fresh  ink  marks  from  spreading. 

Dental  Uses. —  In  dental  practice,  sandarach,  dissolved  in 
alcohol  forms  a  varnish  for  coating  the  surface  of  plaster 
models,  etc. ;  it  is  also  used  for  checking  secretions  from  the 
gums  during  the  operation  of  filling  teeth,  either  applied  as  a 
coating  to  the  surface,  or  on  bibulous  paper  saturated  with  it. 
It  is  also  employed  to  saturate  cotton  to  be  used  as  a  tempo- 
rary filling  in  cavities  of  the  teeth,  for  the  protection  of  medi- 
cinal applications. 

DENTAL   FORMULA. 

Transparent  Sandarach    Varnish, 

R .     Gum  sandarach ^  v. 

Alcohol qt.j. 

Mix  and  digest  over  a  moderate  heat  until  the  sandarach  is  dissolved. 

SERPENTARIA— VIRGINIA  SNAKEROOT. 

Source. — Serpentaria  is  prepared  from  the  rhizoma  and 
rootlets  of  the  Aristolochia  serpentaria  and  of  the  Aristolocliia 
reticulata,  and  is  composed  of  a  volatile  oil,  resin  and  bitter 
principle.  Its  preparations  are :  Infusum  Serpentaria — Infu- 
sion of  Serpentaria ;  Tinctura  SerpentaricE — Tincture  of  Ser- 
pentaria ;  Extractum  Serpentaricz  Fluidum — Fluid  extract  of 
serpentaria. 

Medical  Properties  and  Therapeutic  Uses. — Serpentaria  is  a 
bitter,  aromatic,  stimulating  tonic,  employed  in  typhoid  and 
typho-malarial  fevers,  and  as  a  stimulant  expectorant  in  capil- 
lary bronchitis ;  also  combined  with  the  carbonate  of  ammo- 
nia in  a  low  form  of  pneumonia,  chlorosis,  anaemia  and  diph- 
theria. Large  doses  cause  diarrhoea,  nausea,  vertigo  and 
headache. 


462  DENTAL  MEDICINE. 


Dose. — Of  Infusion,  oSS  to  Sj ;  Tincture,  5ss  to  5ij ;  Fluid 
extract,  5ss  to  5ij. 

SHELL-LAC— SHELLAC. 

Source. — Lac  is  a  resinous  substance,  obtained  from  several 
varieties  of  trees  which  grow  in  the  East  Indies,  and  particu- 
larly from  the  Croton  Lacciferum,  and  two  species  of  the  Ficiis. 
It  is  supposed  to  be  an  exudation  from  the  bark,  owing  to  the 
puncture  of  an  insect  belonging  to  the  genus  Coccus  ;  it  is  also 
said  to  be  the  exudation  from  the  bodies  of  the  insects  them- 
selves. Several  varieties  are  known  in  commerce,  the  most 
common  being  the  stick-lac,  the  seed-lac  and  the  shell-lac. 
Lac,  in  its  crude  state,  consists  of  resin,  coloring  matter,  and 
a  peculiar  principle,  insoluble  in  water,  alcohol  or  ether,  and 
known  as  lacin,  a  little  wax,  and  various  saline  matters  in 
small  proportion. 

Uses. — It  is  slightly  astringent,  and  has  been  recommended 
as  an  adhesive  substance  for  dressing  ulcers,  wounds,  etc., 
being  used  by  simply  spreading  it  on  the  bandages  after  it  is 
dissolved  in  alcohol  by  a  gentle  heat.  Shellac  is  prepared  by 
melting  the  crude  lac,  straining  it,  and  pouring  it  upon  a  flat, 
smooth  surface  to  harden.  It  is  in  the  form  of  thin  frag- 
ments of  various  sizes,  from  half  a  line  to  a  line  in  thickness, 
and  of  a  light  and  also  a  dark  brown  color,  shining,  hard,  brit- 
tle and  inodorous.  It  is  insoluble  in  water,  but  freely  soluble 
in  alcohol,  especially  with  the  aid  of  heat.  It  is  employed  as 
a  varnish.  In  dental  practice  its  uses  are  the  same  as  those 
of  sandarach,  but  owing  to  the  dark  brown  color  of  the 
solution,  it  is  not  so  sightly,  and  does  not  make  a  transparent 
varnish. 

DENTAL   FORMULA. 
For  a   Colored   Varnish.  For  an  Aqueous  Varnish. 

U .     Gum  shellac ^  v  R .     Pulv.  shellac  ....  partes  j 

Alcohol qt.j.  Sat.  solut.  boracis  .    .  partes  ij 

Mix  and  digest  over  a  moderate  heat  Mix  by  shaking  together ;  it  will  give 

until  thoroughly  dissolved.  a  starch  gloss. 

Shellac  may  be  dissolved,  without  the  aid  of  alcohol,  by  a 
saturated  solution  of  borax  in  water.     This,  however,  does  not 


PHENATE   OF   SODIUM.  463 

give  a  very  strong  solution.  To  prevent  cracking  when  the 
shellac  is  dissolved  in  alcohol,  add  a  little  castor  oil ;  if  in  water, 
add  glycerine.  Clear  shellac  varnish  may  be  prepared  by  first 
making  an  alcoholic  solution  of  shellac  in  the  usual  way,  and 
then  adding  a  little  benzole,  and  the  mixture  well  shaken.  In 
from  24  to  48  hours  the  fluid  will  have  separated  into  two 
distinct  layers,  an  upper  alcoholic  stratum,  perfectly  clear,  and 
of  a  dark-red  color,  while  under  it  is  a  turbid  mixture  con- 
taining the  impurities.  The  clear  solution  is  drawn  off  with  a 
pipe,  or  may  be  decanted. 

SOD^   PHENAS— PHENATE   OF   SODIUM. 
CARBOLATE    OF    SODIUM — PHENOL    SODIQUE. 

Formula. — NaCgHjO. 

Derivation. — Phenate  or  Carbolate  of  Soda  is  obtained  by 
mixing  caustic  soda  with  carbolic  acid  and  a  small  quantity 
of  water,  and  evaporating  the  solution,  the  result  being  a 
saponaceous  mass  of  acicular  crystals  of  a  light  pinkish 
color,  which  are  converted  by  the  heat  into  a  fluid  of  an  oily 
consistence.  It  is  freely  soluble  in  creasote,  carbolic  acid  and 
water. 

Medical  Properties  and  Actiojt, — Phenate  of  soda  is  haemo- 
static, antiseptic  and  disinfectant. 

Therapeutic  Uses. — It  is  internally  administered  in  the  form 
known  by  the  PVench  name  of  Phenol  Sodique,  in  doses  of  gtt. 
viij  or  gtt.  X  in  a  glass  of  water,  in  typhus  and  typhoid  fevers, 
as  a  preventive  of  cholera,  in  plagues,  cholera  infantum,  etc. ; 
externally,  it  is  a  valuable  styptic  in  local  hemorrhage,  and 
as  a  dressing  for  wounds,  burns,  chilblains,  excoriations,  vari- 
cose veins,  venomous  stings  and  bites,  and  as  a  disinfectant 
in  throat  affections,  leucorrhoea,  diphtheria,  scarlatina,  small- 
pox, ozaena,  etc. 

Dental  Uses. — Phenate  of  soda  is  useful  in  dental  practice, 
as  an  astringent  and  styptic  in  hemorrhage  following  the  ex- 
traction of  teeth,  and  to  relieve  the  soreness  of  such  an  opera- 
tion, as  it  promotes  the  rapid  absorption  of  the  extra vasated 
blood,  and  the  healing  and  hardening  of  the  gums.     It  is  ap- 


464  DENTAL   MEDICINE. 


plied  on  a  pellet  of  cotton,  or  in  solution  with  water,  and  acts 
as  a  sedative  and  antiphlogistic  as  well  as  a  haemostatic,  and 
has  little  or  no  escharotic  action.  For  soft  and  spongy  gums 
it  forms  an  efficient  gargle  or  mouth-wash,  and  can  be  em- 
ployed for  this  purpose  in  its  full  strength,  in-  the  form  of 
phenol  sodique,  or  diluted  with  from  one  to  twelve  parts  of 
water.  When  applied  on  cotton,  to  an  exposed  and  inflamed 
pulp,  it  relieves  odontalgia.  It  is  also  employed  in  aphthous 
ulcerations  of  the  mouth,  and  as  a  disinfectant  in  offensive 
breath,  in  the  proportion  of  a  teaspoonful  to  a  glass  of  water. 

DENTAL   FORMULA. 
Phenol  Sodique. 

Pure  melted  carbolic  acid 5  parts 

Solution  of  caustic  soda,  specific  gravity  1 1332    ....  I  part 

Distilled  water 5  parts. 

Mix. 

A  Phenol  Sodique  Preparation. 

R .    Acidi  carbolici gr.  clxxxviij 

Sodse  caustic gr.  xxxj 

Aquae ^  iv.  M. 

SiGNA. — To  be  applied  on   a   pellet  of  cotton,  or,  as  a  mouth  wash,  di- 
luted to  meet  requirements  of  case. 

SODII  BICARBONAS— BICARBONATE  OF  SODIUM. 
SESQUICARBONATE    OF   SODIUM. 

Formula.  — NaHCOg. 

Derivation. — Bicarbonate  of  Sodium  is  obtained  by  saturat- 
ing the  carbonate  of  sodium  with  carbonic  acid.  It  is  in  the 
form  of  a  white,  opaque  powder,  freely  soluble  in  water,  with 
a  mild,  slightly  alkaline  taste. 

Medical  Properties  and  Action. — Bicarbonate  of  sodium  is 
antacid,  alterative,  lithontriptic,  and  from  its  mildness  and 
non-irritating  qualities  is  more  pleasant  to  the  taste  and  to  the 
stomach  than  the  carbonate.  It  is  extensively  used  in  the 
preparation  of  soda  and  seidlitz  powders. 

Therapeutic  Uses. — Bicarbonate  of  sodium  is  internally  ad- 
ministered in  neuralgia  connected  with  acidity  of  the  stomach, 
cardialgia,  flatulence  and  vomiting,  dyspepsia,  diarrhoea,  dis- 


BICARBONATE   OF   SODIUM.  465 

eases  of  the  skin,  albuminuria,  calculous  disease,  etc.  Ex- 
ternally in  diseases  of  the  skin  of  a  scaly  and  papular  nature, 
ecthyma,  ringworm,  and  sprinkled  over  burns  and  scalds,  and 
combined  with  an  equal  part  of  common  salt,  for  stings  of 
venomous  insects. 

Dose. — Of  bicarbonate  of  sodium,  gr.  v.  to  5j,  in  carbonic 
acid  water,  or  with  sugar  and  mucilage. 

Effervescing  Powders. — Piilveris  Effervescentes,  are  com- 
posed of  tartaric  acid,  gr.  xxv,  in  one  paper,  and  bicarbonate 
of  sodium,  gr.  xxx,  in  another  paper. 

De7ital  Uses. — Bicarbonate  of  sodium  is  employed  in  dental 
practice  to  relieve  neuralgia  of  an  acid  origin,  in  which  a  full 
dose  often  proves  very  serviceable ;  in  aphthae  of  children  it  is 
often  combined  with  a  little  rhubarb  and  proves  very  effica- 
cious. Externally  it  instantly  relieves  odontalgia  when  a 
small  portion  of  the  powder  is  applied  to  the  irritable  pulp 
and  properly  secured.  It  is  also  useful  for  neutralizing  the 
acidity  of  the  oral  fluids,  especially  when  such  a  condition  is 
the  result  of  pregnancy.  It  also  forms  an  antacid  ingredient 
in  dentifrices. 

Dr.  E.  C.  Kirk  recommends  a  thick  paste  of  sodium  car- 
bonate as  a  local  sedative  and  obtundent  of  hypersensitive 
dentine,  its  application  to  be  made  to  a  dry  cavity  and  repeated 
when  necessary.  In  acute  periodontitis,  applied  to  the  gums 
after  a  slight  puncture,  it  will  often  afford  speedy  relief  from 
the  pain.  As  a  chemical  disinfectant  and  antiseptic,  Dr.  Leff- 
man  considers  sodium  carbonate  to  be  of  great  value  in  the 
treatment  of  devitalized  teeth  containing  semi-putrescent 
pulps  and  food  debris,  to  be  followed  by  injections  of  warm 
water. 

DENTAL  FORMULA. 

For  Periodontitis,  etc. 

Carl  Seiler. 

B .    .Soflii  Vjicarb ^  viij 

Sodii  hibor 5  viij 

Sodii  benzoate 

Sodii  salicylate aa gr.xx 

Eucalyptol 

30 


466  DENTAL   MEDICINE. 


Thymol aa gr.x 

Menthol gr.v 

Ol.  gaultheria gtt.vj 

Glycerine gviiiss 

Alcoholis §ij 

Aquae, q.s , i6  pints.    M. 

SiGNA. — Use  as  an  antiseptic  spray. 

SODII  BORAS— BORATE  OF  SODIUM. 
BORAX. 

Formula. — 2NaB02,  2HBO2,  9H2O. 

Source. — Borax  is  a  native  salt,  but  can  be  obtained  artifi- 
cially by  boiling  together  native  boracic  acid  (found  in  Italy), 
and  carbonate  of  soda.  California  furnishes  the  borax  used  in 
this  country.  It  is  in  the  form  of  colorless  crystals,  which 
effloresce  somewhat  in  dry  air,  and  are  freely  soluble  in  water 
and  glycerine,  but  insoluble  in  alcohol,  with  an  alkaline  reac- 
tion, and  a  sweetish  alkaline  taste.  It  dissolves  fibrine,  alb.u- 
men,  casein  and  uric  acid. 

Medical  Properties  a?id  Action. — Borax  is  refrigerant,  diuretic, 
detergent,  antacid  and  emmenagogue,  and  has  been  employed 
as  a  solvent  for  calculi.  It  resembles  in  its  action  carbonate  of 
soda,  and  by  its  mild  alkaline  qualities  it  improves  the  condi- 
tion of  the  skin  and  mucous  membranes.  In  excessive  or 
large  repeated  doses  it  is  injurious,  causing  nausea  and  vomit- 
ing, and  a  scorbutic  condition  of  the  body. 

Therapeutic  Uses. — Borax  is  internally  administered  in  infan- 
tile diarrhoea,  in  the  form  of  an  enema ;  also  as  a  solvent  for 
calculi,  and  in  dropsy,  etc.,  but  its  chief  use  is  as  an  external 
application.  Externally  it  is  applied  as  a  detergent  in  cutane- 
ous affections,  ulcerations,  pityriasis,  to  remove  freckles,  to  allay 
itching,  etc.,  etc. 

Dose. — Of  borate  of  sodium,  gr.  ij  to  9j. 

Glycerite  of  Borate  of  Sodium — Glyceritum  SodiiB oralis 
— Glycerinum  Boracis — is  composed  of  borax,  oij ;  glycerine, 
Oss,  and  is  a  useful  application  to  the  mouth  and  throat. 

Honey  of  Borate  of  Sodium — Mel  Sodii  Boratis — Mel 
Boracis — is  composed  of  borax,  5j  ;  clarified  honey,  5j,  and 


BORATE  OF   SODIUM.  467 

is  also  useful  as  a  detergent  application  to  the  mouth  and 
throat. 

Dental  Uses. — Borax,  mixed  with  sugar  or  honey,  is  a  very 
useful  application  for  aphthae  and  other  ulcerations  of  the 
mouth,  for  which  it  may  be  mixed  with  sugar  in  the  propor- 
tion of  one  part  to  seven,  or  in  the  form  of  incl  boracis.  In 
mercurial  stomatitis,  an  aqueous  solution  of  borax,  or  the  mel 
boracis,  forms  an  efficient  gargle.  Borax  is  also  a  useful  appli- 
cation in  fissured  or  cracked  tongue.  Borax  is  also  added  to 
sage  and  balm  teas,  to  form  gargles. 

In  the  dental  laboratory,  borax  is  employed  as  a  flux  in 
melting  metals,  such  as  gold  and  silver,  and  in  the  process  of 
soldering  metals.  It  is  also  employed  to  harden  plaster  casts 
or  models,  the  model  being  well  dried  and  then  immersed  for 
a  few  minutes  in  a  solution  of  borax  in  boiling  water,  which 
renders  it,  when  cool,  hard  and  durable.  (Solutions  of  carbon- 
ate of  soda  and  alum  are  used  for  the  same  purpose.)  Dr.  J. 
L.  Williams  considers  borax  a  valuable  application  to  the 
teeth  of  pregnant  women  to  counteract  acidity  of  the  fluids  of 
the  mouth.  He  recommends  the  use  of  the  powder  applied  to 
the  teeth  and  allowed  to  remain  half  a  minute  or  so,  and  then 
brushed  off  by  a  whirling  motion  of  the  brush,  not  with  a 
horizontal  movement.     Also  useful  to  sterilize  instruments. 

DENTAL  FORMULA. 

A  Mild  Detergent  Gargle.  For  Fissured  or  Cracked  Tongue. 

K-     Sodii  biboratis  .    .    .    .  §j  R.     Sodii  biboratis  .    .    .    .  ^j 

Glycerini 5vj.     M.  Glycerini 5J.        M. 

For     Aphthous     Ulcerations,    Parasitic  To  be  used  as  a  lotion  or  gargle. 

Formations,  and  Diphtheritic  Condi-  c      i-  j  rj, 

^  For  Fissured  Tongue. 

""'^'  T  W  White 

R .     Sodii  biboratis  .    .    .    .  3  ij  J  •      • 

Syrupi  aurantii    .    .    .  ^iv  »•     Sodii  biboratis  .    .    .    .  gr.xl 

Aquae  destillatse  .    .    .  5iv.      M.  Glycenni l\ 

SiGNA.-To  be  applied  as  a  lotion  or  Aquoe  dest.llatce  .    .    .     5iv.     M. 

mouth  wash,  stimulant  and  antiseptic.  '^^  ^^  "^^^  ^^  ^  ^'"■^'^■ 

For  Aphthous   Ulcerations,  etc.,  etc.  ^  Detergent  Alkaline  Gargle. 

R.     So<lii  sulphitis  .    .    .    .  3J  R.     Sodii  biboratis  .    .    .    .  ^iv 

Glycerini ^j.        M.  Glycerini, 

SiGNA. — To    be    used   as  a  lotion    or  Tincturae  myrrhoe  aa   .  ^^ss 

mouthwash.  Aquse  destillatae  .    .    .  3X.       M, 


468  DENTAL   MEDICINE. 


S/ODU  SALICYLAS— SALICYLATE  OF  SODIUM. 

Derivation, — Salicylate  of  Sodium  is  prepared  by  the  addi- 
tion of  salicylic  acid  to  a  solution  of  bicarbonate  of  sodium ; 
when  the  latter  is  in  excess  the  solution  is  brownish  or  purplish 
in  color,  and  has  a  strong  odor  of  wintergreen.  The  formula 
is  as  follows :  I^.  Acidi  salicylici  5ij  ;  sodii  bicarb.  5j ;  aquse 
Sij.     M. 

Dose. — A  teaspoonful  every  2,  3  or  four  hours. 

Dental  Uses. — Employed  as  an  internal  remedy  for  odon- 
talgia, periodontitis  and  the  pain  of  carious  dentine,  affording 
temporary  relief  for  several  days.  Dr.  Thomas  recommends 
doses  of  ten  grains  every  half-hour  for  the  relief  of  odontalgia. 

For  Aphthous  Stomatitis. 

R .     Salicylate  of  soda 20  parts. 

Distilled  water 100     " .  dissolve. 

SiGNA. — Paint  the  inflamed  parts  five  or  six  times  a  day,  particularly  after  meals. 
The  mouth  should  previously  be  well  rinsed  out  with  tepid  water. 

SODII  SULPHIS— SULPHITE  OF  SODA. 

Formula. — Na2S03. 

Derivation. — Sulphite  of  Soda  is  prepared  by  passing  sul- 
phurous acid  into  a  solution  of  carbonate  of  soda,  and  evapo- 
rating free  from  air.  The  sulphurous  acid  unites  with  the 
soda  of  the  carbonate,  to  form  the  sulphite  of  soda,  and  the 
carbonic  acid  escapes.  On  cooling,  the  salt  crystallizes  in 
white  prismatic  crystals,  and  should  be  kept  well  stoppered,  as 
it  changes  on  exposure  into  sulphate  of  soda. 

Medical  Properties  and  Action. — Sulphite  of  soda  is  a  disin- 
fectant and  deodorizer,  and  its  action  and  uses  are  similar  to 
those  of  the  other  sulphites,  hyposulphites  and  sulphurous 
acid. 

Dose. — Of  sulphite  of  soda,  gr,  xv  to  5j,  three  times  a  day. 

Dental  Uses. — Sulphite  of  soda  is  sometimes  employed  in 
the  form  of  a  lotion  for  aphthous  sore  mouth  due  to  a  para- 
sitic vegetable  ;  also  in  ulcerous  stomatitis,  gangrenous  stoma- 
titis, and  all  suppurative  affections  of  mucous  membrane, 
especially  when  they  are  su.stained  by  zymotic  influences  or 


SULPHITE   OF   SODA.  469 


invisible  organisms.  Dr.  E.  C.  Kirk  has  successfully  em- 
ployed sulphite  of  soda  in  combination  with  boracic  acid,  for 
bleaching  discolored  teeth.  (See  Formula.)  His  method  is 
as  follows : — 

Having  adjusted  the  rubber  dam  to  the  tooth  to  be  treated, 
and  one  adjoining  it  on  each  side,  the  cavity  of  decay  is 
cleansed  of  all  debris  and  the  root  filled  with  gold  or  gutta 
percha  for  one-half  its  length.  The  powder,  composed  of  sul- 
phite of  soda  and  boracic  acid,  is  packed  into  the  remaining 
portion  of  the  pulp  canal  and  cavity  of  decay,  leaving  just 
sufficient  space  to  insert  a  temporary  filling  of  gutta  percha  or 
Hill's  Stopping.  After  the  powder  has  been  properly  packed, 
a  drop  of  water  is  permitted  to  fall  upon  it  from  a  drop-tube 
or  a  pellet  of  cotton  wrapped  around  a  broach,  the  object 
being  to  dampen  the  powder,  not  to  wash  it  out.  The  cavity 
of  decay  is  then  filled  with  gutta  percha,  and  the  patient  dis- 
missed until  the  next  sitting,  when  a  second  application  can 
be  made,  which  is  usually  sufficient,  except  in  cases  where  the 
walls  of  the  tooth  are  very  thick  and  much  discolored,  when 
a  third  application  may  be  necessary.  When  the  water  is 
added  to  the  powder  a  chemical  reaction  takes  place,  the 
boracic  acid  unites  with  the  sodium  of  the  sulphite  to  form 
sodium  borate,  at  the  same  time  liberating  the  sulphurous 
acid,  upon  which  the  bleaching  powder  depends. 

DENTAL  FORMULAE. 
For  Aphthous  Sore  Mouth.  For  Same. 

Re  J"      1  I.-.-  ^-  Wallace. 

.     bodii  sulphitis 3  J 

Aqus f^j.M.       R-     ^^^^    sulphitis    .  .    .gr.xxx 

Glycerinae, 
SiGNA. — Apply  as  a  lotion.  .  _  _  -, 

'^^  ■'  Aquae   .    .    ,  aa  .  .    .  ^  ss. 

SiGNA. — To  be  used  on  a  swab  every 
two  hours. 
For  Bleaching  Discolored  Teeth. 
E.  C.  Kirk. 

R.     .Sodii    sulphitis gr.ioo 

Acidi  boracis gr^o 

Mix  by  grinding  together  in  a  warm,  dry  mortar,  to  a  fine  powder, 
which  is  preserved  in  an  air-tight  stoppered  bottle,  and  kept  in  a 
dry  place. 

SiGNA. — (See  Dental  Uses  of  Sulphite  of  Soda.) 


470  DENTAL   MEDICINE. 


SODIUM  SILICO— FLUORIDE. 

Derivation. — A  mixture  of  fluor-spar  and  any  silicious 
substance,  as  sand,  is  heated  in  a  retort  with  HjSO^;  the 
resulting  gas  being  distilled  over  through  mercury  into  water, 
which  holds  it  in  solution,  and  which  is  then  filtered  to 
remove  the  free  silicon  which  precipitates.  This  should  give 
a  perfectly  neutral  reaction  to  litmus  paper. 

Medical  Properties  and  Therapeutic  Uses. — Experiments 
with  this  salt  by  Mr.  Wm.  Thomson,  F.  B.  F.  C,  F.  C.  S., 
showed  that  the  compounds  of  fluorine  were  powerful 
disinfectants,  and  of  these  the  sodium  silico-fluoride  was 
the  most  serviceable.  It  has  been  employed  as  a  substitute 
for  peroxide  of  hydrogen  on  account  of  the  changeable  nature 
of  the  latter  agent.  Even  in  a  saturated  solution,  sodium  silico- 
fluoride  is  not  an  escharotic  coagulant,  but  it  is  a  slight  irri- 
tant in  such  a  form,  which  is  not  a  positive  disadvantage  in 
the  treatment  of  some  affections,  such  as  alveolar  pyorrhoea 
for  example. 

Dental  Uses. — Sodium  silico-fluoride  has  been  used  with 
good  results  in  cases  of  putrescent  pulps,  chronic  alveolar 
abscesses,  pyorrhoea  alveolaris.  Also  as  a  deodorizer  in  pulp 
canals  by  destroying  the  putrescent  matter  by  removing  its 
hydrogen.  As  a  disinfectant,  it  is  powerful  enough,  even  in 
weak  solution,  to  antagonize,  in  a  marked  degree,  the  germs 
of  putrefaction ;  as  a  coagulant,  it  is  non-escharotic ;  as  a 
deodorant,  it  is  strong  enough  to  destroy  the  most  penetrating 
of  putrefactive  odors ;  as  a  stimulant,  it  is  powerful  enough  in 
full  solution  to  bring  about  the  formation  of  new  tissue,  and 
not  act  as  an  irritant  to  surrounding  tissue  ;  it  is  comparatively 
unchangeable.  Such  properties  may  render  it  one  of  the 
most  useful  salts  in  the  dental  pharmacopoeia. 

STENOCARPINE,  or  GLEDITSCHINE. 

Stenocarpine  is  an  alkaloid  obtained  from  the  tree  Gleditschia 
triacanthus.  As  a  local  anaesthetic.  Dr.  Herman  Knapp,  in  his 
experiments  as  to  its  physiological  action,  found  it  to  be  fully  as 


SULPHONAL.  471 


energetic  as  a  cocaine  solution  of  equal  strength  in  producing 
anaesthesia  of  the  cornea  and  conjunctiva.  Dr.  Jackson  found 
that  the  instillation  of  one  drop  of  a  two  per  cent,  solution  of 
stenocarpine  caused  a  slight  smarting,  followed  by  dryness  of 
the  conjunctiva,  dilatation  of  the  pupil,  and  within  two  and  a 
half  minutes  complete  anaesthesia  of  the  conjunctiva  and 
cornea,  lasting  for  about  twenty  minutes.  These  results  were 
obtained  in  sixteen  different  individuals,  in  all  complete  anaes- 
thesia being  obtained  in  one  or  two  minutes,  and  passing  off 
mostly  within  half  an  hour.  Stenocarpine  also  appears  to  pro- 
duce a  wider  dilatation  of  the  pupil  than  other  local  anaesthetics 
used  upon  the  eye.  Applied  to  mucous  membrane  of  the  nose, 
throat,  etc.,  anaesthesia  can  be  readily  produced  to  an  equal,  if 
not  more  marked,  degree  than  can  be  obtained  by  the  employ- 
ment of  a  solution  of  cocaine  of  equal  strength  ;  and  when  ap- 
plied to  the  throat  or  nose  the  senses  of  taste  and  smell  are 
respectively  suspended.  Applied  to  the  skin  externally,  it 
causes  complete  anaesthesia,  the  method  of  application  being 
to  simply  moisten  the  surface,  and  keep  it  continually  moist 
with  the  solution,  when,  after  ten  minutes,  a  needle  may  be 
plunged  into  the  skin  without  the  slightest  sensation.  To 
produce  painless  operations  on  the  healthy  skin,  the  incisions 
must  pass  but  gradually  through  the  skin,  and  as  each  layer 
is  divided,  the  wound  must  be  freely  moistened  with  the  solu- 
tion. As  regards  the  toxicological  action  of  stenocarpine 
when  given  in  large  doses,  the  nature  of  the  symptoms  of 
poisoning  which  it  produces  does  not  appear  to  be  as  yet 
clearly  established.  Dr.  Knapp  states  that  its  action  is  analo- 
gous to  strychnine,  while  Dr.  Jackson  describes  stenocarpine 
as  a  depressor  motor  poison,  and  in  no  case  in  his  experi- 
ments does  he  refer  to  the  production  of  convulsions.  As  far 
as  has  yet  been  determined,  the  physiological  action  of  steno- 
carpine appears  to  be  closely  similar  to  that  of  cocaine. 

SULFONAL— SULPHONAL. 

Formula. — (€1^3)2=  C=(C2H5S02)2. 

Sulfonal  is   in  the  form  of  colorless  prisms,  odorless  and 


472  DENTAL   MEDICINE. 


tasteless.  It  is  easily  soluble  in  hot  water  and  in  alcohol,  and 
but  slightly^  soluble  in  cold  water,  and  melts  at  258°  F.  It 
appears  to  possess  hypnotic  properties  of  considerable  power, 
and  is  regarded  as  prompt  and  reliable,  producing  a  quiet, 
natural  sleep,  lasting  a  number  of  hours.  It  appears  to  have 
no  unfavorable  effects  on  the  heart  or  the  circulation,  nor  on 
the  temperature,  the  pulse  or  the  respiration,  and  to  produce 
no  disagreeable  secondary  symptoms,  nor  to  interfere  with  the 
process  of  digestion. 

It  is  best  administered  in  hot  liquids,  such  as  a  bowl  of 
soup  or  broth,  a  cup  of  milk,  tea,  coffee,  cocoa,  etc. 

The  conclusions  drawn  by  Mathes  are  as  follows:  i.  Sul- 
fonal  is  a  useful  hypnotic  agent,  though  it  is  not  always  effica- 
cious. 2.  It  has  the  advantage  over  other  agents  of  having 
no  odor  or  taste,  and  no  influence  on  the  essential  organs  of 
life.  3.  The  worst  of  its  disagreeable  effects  are  insignificant. 
4.  The  dose  depends  upon  the  individual  susceptibility,  and  is 
therefore  variable.  Generally  a  gramme  is  sufficient  to  cause 
sleep  without  accessory  manifestations.  When  these  are  pro- 
duced the  dose  should  be  diminished.  On  account  of  its 
slow  action,  it  should  be  given  at  least  an  hour  before  the 
time  for  sleep.  5.  When  the  insomnia  is  due  to  irritating 
cough  or  to  pains  not  clearly  neuralgic,  the  use  of  sulfonal  is 
contra-indicated.  In  most  true  neuralgias,  on  the  contrary,  it 
may  be  used  with  benefit. 

It  is  a  valuable  remedy  for  persistent  neuralgia  in  doses  of 
gr.  x-xxx ;  it  may  be  administered  in  hot  liquids  such  as  tea, 
in  the  form  of  tablets  of  five  and  fifteen  grains.  Dr.  Chase 
recommends  sulphonal  very  highly  for  nervous  patients  after 
a  protracted  dental  operation,  as  a  small  dose  will  give  a  quiet 
night's  rest. 

Dose. — Grs.  v  to  grs.  xxx ;  but  variable,  depending  upon 
the  individual  susceptibility. 

Although  sulphonal  is  probably  one  of  the  safest,  as  it  is 
one  of  the  most  efficacious  among  the  recent  hypnotics,  the 
series  of  cases  published  by  Bresslauer,  of  Vienna,  show  clear- 
ly that  it  has  certain  dangers.     Out  of  seventy-seven  feeble 


TERCHLORIDE  OF   PHENOL.  473 

lunatic  patients  who  were  treated  with  this  drug,  no  less  than 
seven  showed  serious  symptoms,  and  in  five  of  these  there  was 
a  fatal  termination ;  but  it  should  be  stated  that  the  patients 
had  been  taking  the  drug  for  a  considerable  time  in  good 
doses,  and  had  borne  it  well  until  symptoms  of  disturbance 
appeared,  such  as  great  constipation,  dark-brown  urine,  slow, 
but  in  some  cases  rapid  but  feeble  pulse,  discolored  patches 
resembling  purpura  on  the  limbs,  and  great  prostration.  In 
the  cases  which  ended  fatally,  the  cause  of  death  was  heart- 
failure,  with  oedema  of  the  lungs. 

The  action  of  sulphonal  upon  digestion  is  as  follows: 

a.  Strong  solutions,  saturated  or  half  saturated,  consider- 
ably delayed  digestion,  and  that  the  stronger  the  solution  the 
greater  was  the  retardation. 

b.  Weak  solutions,  such  as  ^ig^  or  ^  of  a  saturated  solution, 
had  little  effect  either  in  accelerating  or  delaying  digestion, 
but  when  ^  of  a  saturated  solution  was  employed,  delay  in 
digestion  took  place. 

c.  Strong  or  weak  solutions  had  no  marked  effect  in  re- 
tarding putrefaction. 

TERCHLORIDE  OF  PHENOL. 

Derivation. — Terchloride  of  Phenol  has  recently  been  intro- 
duced as  a  disinfectant  and  antiseptic.  It  is  prepared  by 
passing  a  stream  of  chlorine  gas  through  chemically  pure 
carbolic  acid,  previously  melted,  until  it  acquires  a  violet 
hue.  When  carbolic  acid  is  acted  upon  by  chlorine  gas  a 
number  of  compounds  are  produced ;  such  as  a  mono- 
chloride,  a  bichloride  and  a  tri-or  ter-chloride  of  carbolic 
acid  (phenol). 

Medical  Properties  ajid  Action. — It  is  not  an  irritant,  and  has 
no  acid  reaction. 

Therapeutic  and  Dental  Uses. — Terchloride  of  phenol  is 
claimed  to  be  a  valuable  antiseptic  and  disinfectant  in  the 
treatment  of  gangrenous  ulcers,  etc.  In  dental  practice  it  has 
been  very  recently  recommended  in  combination  with  iodo- 
form, as  a  material  for  capping  exposed  pulps  and  as  a  filling 


474  DENTAL   MEDICINE. 

for  root  canals  of  teeth,  and  the  advantages  claimed  for  it  are, 
that  it  will  be  resorbed  when  in  contact  with  living  tissues ; 
it  is  easily  introduced  into  pulp  canals ;  it  absorbs  exudations  ; 
it  becomes  hard  when  mixed  with  certain  chemical  substances, 
but  is  destroyed  by  pus ;  it  is  a  very  bad  conductor  of  heat ; 
and  it  is  absolutely  a  non-irritant.  The  method  recom- 
mended for  its  use  as  a  capping  and  filling  material  is,  to 
incorporate  iodoform  and  terchloride  of  phenol  with  de- 
calcified dead  bone,  as  follows :  dead  bone  or  ivory  shavings 
are  decalcified  in  a  ten  per  cent,  solution  of  chemically  pure 
hydrochloric  acid,  and  after  all  the  lime  salts  are  extracted, 
the  residue  is  collected  upon  a  filter,  washed,  dried  and  rubbed 
to  a  fine  powder  in  a  porcelain  or  glass  mortar.  Upon  this 
powder  ten  times  its  weight  of  a  ten  per  cent,  solution  of 
iodoform  in  sulphuric  ether  is  gradually  poured  and  constantly 
rubbed  until  a  fine  yellow  powder  is  obtained,  which  contains 
about  fifty  per  cent,  of  iodoform.  When  used  as  a  capping 
for  pulps,  or  a  filling  material  for  root  canals  of  teeth,  this 
powder  is  made  into  a  paste  by  the  addition  of  carbolic  acid 
or  terchloride  of  phenol,  being  worked  or  rubbed  together 
like  ordinary  cement.  For  hypersemic  conditions  of  the  den- 
tal pulp  success  has  attended  the  application  of  a  cap  of  the 
iodoform  and  decalcified  bone  paste  mixed  with  terchloride  of 
phenol.  For  inflamed  pulps  the  application  of  terchloride  of 
phenol  is  to  be  repeated  every  third  or  fifth  day,  until  no  more 
pain  is  felt,  and  the  pulp  is  then  to  be  capped  with  the  de- 
calcified bone,  iodoform  and  terchloride  of  phenol  material, 
and  a  temporary  filling  introduced  into  the  crown  cavity. 
The  treatment  of  ulcerated  and  gangrenous  pulps  of  teeth 
consists  in  treating  with  the  terchloride  of  phenol,  and  after 
the  second  or  third  application,  if  no  trouble  occurs  from  a 
temporary  closure  of  the  root  canals,  to  fill  with  the  decalci- 
fied bone,  iodoform  and  terchloride  material,  using  whalebone 
instruments  for  its  introduction,  until  congelation  is  occa- 
sioned, and  the  congested  condition  of  the  capillaries  of  the 
part  relieved,  acting  as  a  counter-irritant  and  antiphlogistic. 


TURPENTINE.  475 


TEREBINTHINA— TURPENTINE. 

Source. — The  concrete  oleo-resin  oi Pinus  australis  and  vari- 
ous species  of  pine. 

Oleinn  Terebinthince. — Oil  of  Turpentine  obtained  by  distil- 
lation. 

Formula. — C,oHjg. 

Oil  of  Turpentine  is  a  limpid,  volatile,  colorless  oil,  with  a 
hot  pungent  taste  and  a  strong  peculiar  odor.  It  is  slightly- 
soluble  in  water.  In  small  doses  it  increases  the  action  of  the 
heart,  elevates  the  arterial  tension  and  causes  a  sense  of  warmth 
and  exhilaration. 

In  large  doses  it  causes  thirst,  fever,  vomiting,  weakness, 
and  a  species  of  intoxication.  In  poisonous  doses  there  is 
complete  muscular  relaxation,  insensibility,  flushed  face,  di- 
lated pupils,  labored  and  stertorous  breathing.  It  stimulates 
the  vaso-motor  system,  and  has  marked  antiseptic  properties, 
arresting  fermentation  and  putrefaction,  and  destroying  micro- 
organisms. Inhalation  of  the  vapor  of  turpentine  causes 
headache,  nasal  and  bronchial  irritation,  ecchymosis  of  the 
air-passages,  hypersemia  of  the  kidneys  and  congestion  of  the 
lungs. 

The  ozonized  oil  of  turpentine  is  an  antidote  to  phosphorus, 
by  the  power  it  possesses  of  converting  the  agent  into  an  in- 
soluble substance ;  and  a  vial  of  turpentine  worn  about  the 
neck  prevents  necrosis  of  the  jaw  and  steatosis  in  workmen 
using  phosphorus  in  manufactories. 

Sanitas  is  a  highly  ozonized  preparation  of  turpentine,  and 
is  used  as  an  antidote  to  phosphorus  poisoning.  (See  Oil 
of  Sanitas.) 

Oil  of  turpentine  is  employed  in  flatulence,  colic,  chronic 
intestinal  catarrh,  constipation  and  as  an  anthelmintic ;  also  in 
passive  hemorrhages  from  mucous  surfaces,  taenia  and  as  a 
stimulant  in  low  fevers.  In  the  form  of  enemata  for  colic, 
tympanitic  distension  and  impaction  of  faeces,  etc.;  in  the  form 
of  liniment  for  myalgia,  neuralgia,  lumbago,  etc. ;  also  for 
burns,  erysipelas  and  chilblains. 


476  DENTAL   MEDICINE. 


Terebinthene  (Qo^ie)  ^^  ^  hydrocarbon  formed  by  the  dis- 
tillation of  turpentine  with  an  alkali.  Terebinthene  is  con- 
verted by  hydration  into  a  solid  crystalline  body,  known  as 
terpine ;  and  terpine  is  converted  into  terpinol  by  an  acid. 
Terebene  is  derived  from  turpentine  by  the  action  of  sul- 
phuric acid.  These  derivations  are  used  in  bronchitis,  broncho- 
pneumonia, asthma,  etc.  In  dental  practice  terpinol  is  em- 
ployed as  an  antiseptic,  disinfectant  and  sterilizer. 

Dose. — Oil  of  turpentine,  TTLv  to  Sss ;  of  terebinthene- 
terpine,  gr.  v  to  gr.  xx ;  of  terpinol,  gr.  ij  to  gr.  v ;  of  terebene, 
mv  to  XX. 

Linimentum  Terebinthince — Liniment  of  Turpentine,  is  com- 
posed of  oil  of  turpentine  thirty-five  parts  and  resin  cerate 
sixty-five  parts. 

Oil  of  Sanitas — Oletim  Saiiitas,  is  obtained  by  the  oxidation 
of  oil  of  turpentine  flioating  on  water,  by  directing  a  stream 
of  heated  air  on  its  surface.  Sanitas  oil  is  an  antiseptic 
and  disinfectant,  possessing  considerable  oxidizing  power.  It  is 
non-irritant  and  non-poisonous,  and  its  odor  is  similar  to  that 
of  fresh  pine.  The  oils  of  cinnamon,  gaultheria  and  sassafras 
will  disguise  its  odor.  In  dental  practice,  the  oil  of  sanitas  has 
been  very  successfully  employed  in  alveolar  pyorrhoea,  alveolar 
abscess,  diseases  of  mucous  membrane,  exposed  pulps,  abscess 
of  the  antrum,  foul  ulcers,  wounds  and  ulcerated  sore  throat; 
also  as  a  protection  against  phosphorus  poisoning  and  phos- 
phor-necrosis of  the  jaw. 

Oil  of  Turpentine  is  also  employed  as  a  sterilizer  of  surgi- 
cal and  dental  instruments,  gauze,  bandages,  towels,  etc.  The 
method,  which  is  simple,  consists  in  placing  the  oil  of  turpen- 
tine in  flat,  large-mouthed  bottles  at  the  bottom  of  each  case 
or  drawer,  the  volatility  of  the  agent  causing  the  vapor  to 
impregnate  the  surrounding  air. 


THYMOL. 


Formula. — QoHj^O. 


Derivation. — Thymol,  or  thymic  acid,  is  obtained  from  the 
herb  thymus  vulgaris,  or  common  thyme,  which  is  cultivated 


THYMOL.  477 

in  this  country  for  the  same  purpose  as  sage,  lavender,  etc. 
Thyme  yields  a  volatile  oil,  oleum  tliymi,  from  which  thymol, 
or  thymic  acid,  is  obtained  by  treating  the  oil  with  an  aque- 
ous solution  of  potassa  or  soda,  which  separates  it  from  a 
principle  called  thyinene,  with  which  it  is  mixed  in  the  oil, 
and  which  is  not  affected  by  the  alkalies.  The  thymate  thus 
formed  is  decomposed  by  an  acid,  and  the  liberated  thymol, 
or  thymic  acid,  is  purified  by  repeated  washings,  desiccation 
and  distillation.  Thymol  is  in  the  form  of  aromatic  white 
crystals,  soluble  in  one  thousand  parts  of  hot  water. 

Medical  Properties  and  Action. — In  a  concentrated  state, 
thymol  has  an  acrid  and  caustic  taste ;  but  when  very  much 
diluted,  the  only  taste  experienced  is  that  of  thyme. 

Thymol  has  acrid  properties,  and  is  similar  in  its  action  to 
carbolic  acid.  It  imparts  a  sense  of  coolness  to  the  mouth, 
like  that  of  oil  of  peppermint,  and  when  once  melted,  it  re- 
mains indefinitely  in  the  liquid  state. 

While  it  is  only  slightly  soluble  in  water,  it  is  freely  solu- 
ble in  alcohol,  and  is  dissolved  by  ether  and  the  fixed  oils. 
The  alkalies  unite  with  it  to  form  soluble  salts.  Like  crea- 
sote,  it  has  the  property  of  combining  with  animal  tissues, 
and  thus  prevents  putrefaction.  While  it  has  the  important 
practical  properties  of  carbolic  acid,  it  is  free  from  disagree- 
able odor,  and  it  is  claimed  to  be  as  efficient  an  antiseptic  as 
that  agent. 

Therapeutic  Uses. — Thymol  is  almost  exclusively  employed 
as  an  external  application,  and  is  often  substituted  for  the  oil 
of  origanum,  which  is  obtained  from  the  common  marjoram. 
It  is  considered  to  be  a  valuable  antiseptic  and  antifermenta- 
tive  agent. 

Dental  Uses. — Thymol,  when  combined  with  glycerine,  in 
a  form  known  as  Glycerole  of  Thymol,  is  a  valuable  antiseptic 
in  the  treatment  of  suppurating  pulps  of  teeth,  as  a  dressing 
for  ulcers  of  the  mouth,  \Vounds,  etc.;  also  in  the  treatment 
of  teeth  after  the  devitalization  of  the  pulp,  chronic  inflamma- 
tion of  the  pulp,  and  alveolar  abscess,  as  it  arrests  the  putre- 
factive process ;  also  in  stomatitis  and  abrasion  of  mucous 
membrane. 


478 


DENTAL   MEDICINE. 


DENTAL 
Glycerole  of  Thymol. 
R .     Thymolis  (cryst.)  .    .    .  gr.  xx 
Glycerini, 

Alcoholis  .    .  aa  .    .    .  f^j 
Aquse  destillatse  .   .    .    .  Oj.     M. 

For  Alveolar  Abscess,  Suppurating 
Pulps,  etc. 
Alvin. 
R.     Thymolis  (cryst.)  .   .    .  ptm.j 

lodi ptm.j 

Potassii  iodidi  ....  ptm.j 

Glycerini pts.  v  to  xv. 

SiGNA. — Apply  as  in  use  of  carbolic 
acid. 

For  Stomatitis. 
Alvin. 

R .     Thymolis  (cryst.)  .  .    .  ptm.  j 

Glycerini pts.  loo. 

SiGNA.— To  be  used  as  a  lotion  and 
gargle. 

For  an  Antiseptic  in  Suppurating  Pulps, 

Alveolar  Abscess,  etc. 
R.     Thymolis  (cryst.) .   .    .  ptm.  I 

Glycerini pts.  ij  to  iv. 

SiGNA. — Applied  in  the  same  manner 
as  carbolic  acid. 

Antiseptic  and  Germicide  Mouth-  Wash. 
W.  D.  Miller. 

R ,     Thymol grs.  iv 

Benzoic  acid    ....  grs.  45 

Eucalyptol '^zYz 

Alcohol 325 

Oil  of  wintergreen  .    .  gtt.  25.  M. 

An  Antiseptic  Gargle. 

R.     Thymol 3^grs. 

Benzoic  acid  ....  45    grs. 
Tine,  of  Eucalyptus  180   grs. 

Water 11,250   grs.    M. 

SiGNA. — After  cleansing  the  teeth,  use 
as  a  gargle  for  half  a  minute  or  a 
minute. 


FORMULA. 

Antiseptic  Fluid. 
VOLKMANN. 

R.     Thymol i  part 

Alcohol 10  parts 

Glycerin 20  parts 

Water 100  parts.  M. 

SiGNA. — Apply  as  a  lotion. 
For  Stomatitis. 
David. 

R .     Thymol g^-  vij 

Borax gi"-  xv 

Water giss.   M. 

SiGNA. — Use  as  a  tonic  and  antiseptic 
mouth-wash,  by  placing  a  few  drops 
in  a  wine-glass  of  warm  water. 
For  Fetid  Breath  from  Deposits  about 
Tonsils  and  Gums. 
David. 
R .     Borate  of  Sodium  .    .    .  gr.  xv 

Alcohol gss 

Thymol gr.  vij 

Water Oj.     M. 

SiGNA, — Use  as  a  mouth  wash. 
Antiseptic  Mouth  Wash. 
Dr.  W.  p.  Miller. 
R.     Thymohs gr.  ij 


Acidi  benzoici    ,    .    .  gr.  xlvj 
Hydrarg.  bichlor.  .    .  gr.  ix 
Tinct.  eucalypti .   .    .  §  ss 
Olei  peppermint    .    .  gr.  xj 

Alcoholis S^xvj.    M. 

Filter  and  add  sufficient  of  the  solu- 
tion to  a  wine-glass  of  water. 
SiGNA. — Rinse  with  this  mixture  twice 
sufficiently  to  sterilize  mouth. 
For  a  Nerve  Paste. 
Dr.  S.  H.  McNaughton. 

R .     Thymolis gr.  xxiv 

Camphorse gr.  xij 

Acidum  arseniosum      .  gr.  iij.  M. 
If  much  pain  follows  the  application 
of  the   above,  apply  at   once   without 
washing  out  the  cavity : 

R .     Camphorse gr.  60 

Acidi  tannici gr-  3° 

Alcoholis gj       M. 


TRICHLORPHENOL.  479 


TRICHLOROACETIC  ACID— ACIDUM   TRICHLOROACET  ICUM. 

Formula. — CCI3C02H. 
Trichloroacetic  acid  is  a  crystalline  body,  readily  soluble  in 
water  and  alcohol,  with  an  agreeable  odor.  It  coagulates 
albumen,  and  its  concentrated  solutions  are  caustic.  Diluted 
solutions  cause  an  increased  secretion  of  saliva,  and  destroy  its 
power  to  convert  starch  into  sugar  ;  it  also  arrests  the  digestive 
action  of  pepsine.  As  an  antiseptic  it  has  been  employed  in 
putrid  and  indolent  wounds,  in  the  form  of  weak  solutions,  which 
are  unirritating,  and  promotes  healthy  granulations  and  cicatri- 
zation ;  it  has  also  been  employed  externally  in  erysipelas  and 
venereal  sores.  Internally  it  has  been  recommended  by  Dr. 
Filippowitch  as  a  preventive  of  cholera,  in  doses  of  gr.  ij  to  iij, 
three  or  four  times  daily.  Externally,  it  is  employed  in  one  or 
two  per  cent,  solutions.  The  common  dose  is  gr.  ij  to  v.  in 
very  dilute  solution,  three  times  a  day.  It  has  also  been  used 
internally  for  gastric  catarrh,  and  the  summer  complaint  of 
children  ;  for  the  latter,  in  doses  of  gr.  J^  to  i,  three  times 
daily.  In  a  two  per  cent,  solution  it  destroys  all  forms  of 
organic  life  ;  in  five  per  cent,  solution  it  arrests  the  growth  of 
bacteria  and  micrococci. 

TRICHLORPHENOL. 

Derivation. — Trichlorphenol  is  obtained  by  combining  chlor- 
inated lime  and  carbolic  acid.  One  pound  of  a  solution  of  car- 
bolic acid  (four  per  cent,  solution),  is  mixed  with  five 
pounds  of  solution  of  chlorinated  lime  and  then  filtered.  If 
too  strong,  it  can  be  diluted  with  boiling  water  to  the  required 
strength. 

Medical  Properties  and  Therapeutic  Uses. — Trichlorphenol 
has,  according  to  Diannin,  an  antiseptic  power  twenty-five  times 
greater  than  carbolic  acid,  and  also  exceeding  that  of  thymol, 
salicylic  acid,  and  chlorinated  lime.  A  one  per  cent,  solution 
has  been  employed  in  the  treatment  of  ulcers.  It  has  also 
been  employed  in  the  form  of  solution  in  erysipelas,  and  as  an 
injection  in  leucorrhoea  and  dysentery. 


480  DENTAL   MEDICINE. 


URETHAN.  URETHANE. 

Derivation. — Urethan  is  a  combination  of  carbonic  acid  and 
ethylic  ether.  It  occurs  in  white  crystals,  without  odor,  taste- 
less and  insoluble  in  water. 

Medical  Properties  and  Therapeutic  Uses. — Urethan  is  a 
hypnotic  which  may  be  employed  to  cause  quiet  and  sleep 
when  the  conditions  are  favorable  to  its  action.  It  is  similar 
to  paraldehyde  and  has  no  irritating  effect  upon  the  stomach  nor 
does  it  impair  digestion.  Although  insoluble  in  water,  the 
fluids  of  the  stomach  dissolve  it  readily,  and  it  promptly 
diffuses  into  the  blood.  The  first  effect  of  its  action  is  stimu- 
lating, which  is  of  brief  duration,  then  a  diminution  of  action, 
slowing  of  circulation  and  respiration,  decline  of  temperature 
and  weakening  of  the  reflexes  which  finally  disappear,  then 
drowsiness  and  tranquil  sleep,  and,  if  the  quantity  given  be 
toxic,  coma  and  insensibility.  Fifteen  and  one  half  grains  are 
held  sufficient  to  cause  sleep.  It  is  not  an  analgesic,  hence 
pain  will  prevent  its  hypnotic  action.  Unpleasant  after  effects 
do  not  occur,  except  when  stomachal  troubles  are  present  and 
it  is  seldom  that  there  is  headache,  nausea,  or  vertigo.  Sleep 
is  produced  in  fifteen  minutes  to  an  hour,  and  continues  from 
six  to  eight  hours.  It  has  been  emploj^ed  with  benefit  in 
epilepsy,  chorea,  spasms,  cramp,  delirium  tremens,  tetanus, 
etc.     Its  action  upon  digestion  is  as  follows  : 

a.  Strong  solutions — that  is,  0.5  gramme,  0.25  gramme, 
0.175  gramme — delayed  digestion;  that  the  stronger  the  solu- 
tion the  greater  was  the  delay. 

b.  Weak  solutions — that  is,  i,  2  and  3  milligrammes— nei- 
ther delayed  nor  accelerated  digestion. 

c.  Neither  strong  nor  weak  solutions  retarded  decomposi- 
tion. 

VALERIANA— VALERIAN. 

Source. — Rhizoma  and  rootlets  of  Valeriana  officinalis.  Va- 
lerian contains  a  volatile  oil,  and  from  it  are  several  prepara- 
tions, among  them  valeric  acid,  HCgHgOg,  to  which  the  virtues 


VASELINE.  481 


of  the  agent  are  principally  due.  This  acid  is  now  prepared 
from  fusel  oil,  and  is  not  the  same  as  that  from  valerian 
although  it  is  largely  used  as  a  substitute. 

Valerianates  are  made  from  the  acid  prepared  from  fusel 
oil,  but  are  not  as  good  as  the  preparations  from  valerian.  The 
official  valerianates  are  Ammonii  valerianas  (N.HJC5H9O2; 
dose,  gr.  ij  to  x.  Ferri  valerianas,  Fe  (Cg  1^902)6;  dose,  gr.  j  to 
iij,  Quininae  valerianas;  dose,  gr.  j  to  iij.  Zinci  valerianas 
{C^Wf^-^W^O  \  dose,  gr.  1^  to  ij. 

Medical  Properties  and  Uses. — Valerian  and  its  preparations 
have  a  peculiar,  disagreeable  odor  and  a  hot,  pungent  taste, 
with  a  sensation  of  warmth  at  the  epigastrium,  being  a  gentle 
stimulant  and  antispasmodic.  In  moderate  doses  the  action 
of  the  heart  is  increased,  with  a  rise  of  temperature  and  dia- 
phoresis. Large  doses  cause  nausea,  hiccough,  eructations, 
vomiting  and  diarrhoea.  Small  doses  have  no  apparent  physio- 
logical effects.  It  antagonizes  strychnine.  Valerianic  acid  is 
apparent  in  the  breath,  perspiration  and  urine.  Valerian  is 
frequently  employed  in  hysteria  and  general  nervousness,  as 
are  also  the  valerianates ;  also  in  flatulence,  whooping-cough, 
neuroses  of  the  respiratory  organs,  epilepsy,  chorea,  paralysis 
agitans,  diabetes,  etc.  Valerianate  of  ammonia  is  used  in  ner- 
vous headache  and  in  dental  and  other  neuralgias.  (See  Va- 
lerianate of  Ammonia.) 

Dose. — Of  Abstractum  Valeriance — Abstract  of  valerian,  gr. 

V  to  3j.     Of  Extracium   Valeria?ics  Fliiidum — Fluid  extract  of 

valerian,  5ss    to    .5ss.       Of   Tinctura  Valeriana; — Tincture    of 

valerian,  oss  to  5ij-     Oi  Oleum   Valeriana — Oil  of  valerian, 

mij  to  miv. 

VASELIN— VASELINE. 

PETROLEUM   OINTMENT — PETROLATUM,  COSMOLINE. 

Derivation. — Vaseline  is  obtained  from  crude  petroleum,  in 
the  form  of  a  petroleum  jelly.  In  distillation  of  crude  petro- 
leum there  remains  in  the  apparatus,  after  the  separation  of  the 
light  oils,  a  semi-liquid  tar,  which  constitutes  crude  vaseline, 
which,  in  such  a  state,  has  a  disagreeable  odor  like  petroleum, 
of  a  strong  taste  and  black  color.  This  compound  is  heated 
31 


482  DENTAL   MEDICINE. 


in  the  open  air,  and  decolorized  by  animal  charcoal,  the  pro- 
duct being  the  petroleum  jelly  known  as  vaseline,  which  is 
a  mixture  of  several  hydrocarbons. 

When  pure,  vaseline  is  white,  inodorous  and  insipid,  and 
of  the  consistence  of  jelly,  or  very  unctuous  fat.  It  melts  at 
35°  C,  boils  at  150°  C,  and  distills  at  200°  C,  and  burns 
without  residue.  Exposed  for  a  considerable  time  to  light,  it 
acquires  a  slight  odor  of  petroleum.  It  is  insoluble  in  water, 
sparingly  soluble  in  alcohol,  and  very  soluble  in  warm  ether, 
chloroform,  fats,  volatile  oils,  and  sulphide  of  carbon.  It  sen- 
sibly dissolves  iodine,  bromine,  sulphur,  phosphorus,  carbolic 
acid,  benzoic  acid,  atrophine  and  strychnine. 

Medical  Properties  and  Action. — By  its  composition,  vaseline 
is  not  capable  of  becoming  rancid,  nor  of  being  saponified ; 
hence  it  is  a  very  useful  agent  or  excipient  for  caustic  alkalies, 
oxides,  metallic  salts,  and  even  acids  in  the  cold  without  ac- 
tion by  them,  and  without  modifying  their  therapeutic  proper- 
ties. Incorporated  in  ointments,  a  certain  quantity  of  vaseline 
will  preserve  them  and  obviate  rancidity,  being  preferable  to 
lard,  butter,  glycerine  and  glyceroles.  The  addition  of  par- 
affin will  give  it  any  consistency  desired. 

Therapeutic  Uses. — Vaseline  is  used  externally  as  a  dress- 
ing for  wounds,  cuts,  bruises,  sprains,  piles,  rheumatism,  skin 
diseases,  eczema,  inflamed  surfaces,  diseases  of  the  eye,  etc., 
etc.  Combined  with  carbolic  acid,  it  forms  a  very  useful 
ointment  for  affections  of  the  skin,  etc.,  etc. 

Dental  Uses. — Vaseline  is  an  efficacious  application  to  in- 
flamed and  excoriated  surfaces  of  the  gums  and  mucous  mem- 
brane of  the  mouth;  also  as  a  dressing  introduced  into  the 
canals  of  teeth  affected  with  periodontitis,  and  as  an  emollient 
application  after  the  devitalization  and  removal  of  dental  pulps. 
Carbolated  cosmoline  on  cotton  has  been  employed  for  filling 
root  canals,  but  the  results  have  not  in  all  cases  been  satisfac- 
tory. 

In  the  form  of  Vaseline  Camphor  Ice,  it  is  a  pleasant  and 
efficacious  application  to  chapped  lips  and  hands,  being  bland 
and  non-irritating  in  its  action. 


VERATRINE.  483 


An  ointment  made  by  dissolving  and  incorporating  thor- 
oughly by  the  aid  of  heat,  equal  parts  of  vaseline  and  lead 
plaster,  to  which  a  little  bergamot  may  be  added  for  perfume 
is  very  serviceable  for  the  treatment  of  excoriated  surfaces, 
and  dry  desquamating  surfaces  of  certain  skin  diseases,  and 
especially  the  form  of  skin  affection  which  may  result  from 
the  constant  use  of  scented  soaps  on  the  hands. 

DENTAL   FORMULA. 
Local  An<ESthetic. 
Dr.  Poinsot. 
R,     Oleo-naph thine  (liquid  vaseline), 

Arachis  oil aa 50  centigrammes. 

Pure  cocaine 5  centigrammes. 

M. — Dissolve  the  cocaine  in  a  hot  water  bath  and  wash  gum  where 

the  injection  is  to  be  made  with  absolute  alcohol.     Make    ' 
a   number  of  injections   around   tooth   slowly,  and  wait  8 
minutes. 

VERATRINA— VERATRINE, 

Source. — Veratrine  is  an  alkaloid,  or  a  mixture  of  alkaloids, 
obtained  from  the  seeds  of  asagrcea  officinalis,  of  the  natural 
order  Melanthacecs.  It  is  in  the  form  of  a  white,  or  grayish- 
white  amorphous  powder,  of  an  acrid  taste,  imparting  a  sensa- 
tion of  tingling  and  numbness  to  the  tongue,  and  causing  con- 
striction of  the  fauces  and  violent  sneezing.  It  is  but  slightly 
soluble  in  cold  or  hot  water,  to  which  it  imparts  an  acrid  taste 
and  a  somewhat  alkaline  reaction. 

It  is  soluble  in  three  parts  of  alcohol  at  59°  F.,  and  very 
soluble  in  boiling  alcohol ;  also  soluble  in  6  parts  of  ether,  in 
2  parts  of  chloroform,  and  in  96  parts  of  glycerin ;  it  melts 
when  heated. 

Veratrine  Ointment — UnguentumVeratrince — is  composed 
of  veratrine,  4  parts ;  alcohol,  6  parts ;  benzoinated  lard,  96 
parts.  The  veratrine  is  rubbed  with  the  alcohol  in  a  warm 
mortar  until  dissolved,  and  the  benzoinated  lard  gradually 
added  and  thoroughly  mixed. 

Therapeutic  Uses. — Veratrine  is  only  used  externally  in  neu- 


484  DENTAL   MEDICINE. 


ralgia,  myalgia,  headache,  rheumatism,  paralysis,  etc.,  in  the 
form  of  the  ointment,  or  dissolved  in  alcohol. 

Dental  Uses. — Veratrine,  in  the  form  of  the  ointment,  is  used 
for  facial  and  other  forms  of  neuralgia,  a  small  quantity  being 
rubbed  over  the  seat  of  pain.  It  is  also  used  as  an  obtundent 
of  sensitive  dentine. 

DENTAL  FORMULAE. 
For  Sensitive  Dentine.  For  Facial  Neuralgia. 

BoGUE.  Garretson. 

R .     Veratrinae gr.iv  R .     Veratrinas gr.iv 

Acidum  tannicum    .    .  gr.j  Aconitinse gr.ij 

Alcoholis gtt.xx  Olei  tiglii gtt.ij 

Glycerini i^]  Olei  olivse gij.       M. 

Acidi  carbolici .   .    .    .  ^ij.       M.  Signa. — Rub  over  affected  spot  thrice 
SiGNA. — Dry  the  tooth  thoroughly  and  daily, 

apply  to  sensitive  surface. 

VERATRUM  VIRIDE— AMERICAN  HELLEBORE. 
POKE   ROOT. 

Source. — Veratrum  Viride,  of  the  natural  order  Melanthacece, 
the  officinal  portion  of  which  is  the  root,  is  indigenous  to  the 
swampy  portions  of  the  United  States,  and  is  prepared  in  the 
form  of  slices  or  fragments,  of  a  dark  or  blackish-gray  color 
externally,  and  of  a  grayish-white  color  internally.  Its  odor 
is  peculiar,  especially  when  it  is  moistened,  and  its  taste  is 
bitter  and  acrid.  It  is  inodorous,  but  in  the  form  of  powder 
is  sternutatory.  It  is  similar  in  chemical  composition  to  vera- 
trum album —  white  hellebore  and  veratrum  sabadillse.  Like 
veratrum  album,  it  contains  a  quantity  of  soft  resin,  and  two 
alkaloids— j'ervia  and  veratroidia. 

Medical  Properties  and  Action. — Veratrum  viride  is  acrid  and 
sedative,  causing  redness  and  heat  when  applied  to  the  skin, 
and  has  a  violent  sternutatory  effect  on  the  Schneiderian  mem- 
brane. Small  doses  stimulate  the  secretions  and  depress  the 
pulse.  Although  a  prompt  emetic,  its  operation  is  attended 
with  intense  nausea  and  depression,  and  violent,  persistent 
vomiting.  Large  doses  occasion  great  depression,  with  a  weak 
action  of  the  heart  and  pulse,  vomiting,  retching,  cold  sur- 


XANTHOXYLUM.  435 


face  of  body,  a  cold  perspiration,  faintness,  dimness  of  sight, 
dilatation  of  the  pupils,  great  muscular  weakness,  slow  respi- 
ration, and  sometimes  coma,  insensibility  and  stertorous 
breathing,  but  notwithstanding  such  symptoms,  fatal  results  are 
rare.  The  antidotes  are  free  stimulants.  The  tincture — 
TmctKra  Veratri  Viridis,  is  the  best  preparation  for  internal 
administration. 

Therapeutic  Uses. — Veratrum  viride  is  not  employed  for  its 
emetic  effect,  on  account  of  its  violent  action.  Internally  it  is 
administered  in  diseases  of  the  heart,  active  hemorrhage  in 
the  plethoric,  to  reduce  the  temperature  and  pulse  in  "typhoid 
and  other  fevers,"  in  acute  mania  and  delirium,  in  puerperal 
convulsions,  neuralgia,  neuralgic  headache,  etc.  Externally 
it  is  employed  for  neuralgia,  myalgia,  headache,  rheumatism, 
paralysis,  etc. 

Dose. — Of  the  tincture  of  veratrum  viride,  TTLi  to  TTlv;  of  the 
fluid  extract  of  veratrum  viride — Extractuni  Veratri  Viridis 
Fluidiwi,  mij  to  niv;  veratrina,  gr.  -^  to  gr.  ^. 

Dental  Uses — In  dental  practice,  the  tincture  of  veratrum 
viride  has  been  employed  internally  for  neuralgia  of  the  fifth 
nerve ;  also  in  periodontitis,  as  a  sedative ;  also  in  severe 
hemorrhage  from  the  extraction  of  teeth,  to  depress  the  heart's 
action. 

DENTAL    FORMULA. 
For  Facial  Neuralgia. 
Da  Costa. 

R  .     Veratrise grxv 

Aconitiae gr.ij 

Glycerinae f^ij 

Cerati  adipis f^vj.  M. 

SiG. — To  be  rubbed  over  painful  part,  care  being  taken  to  see  that 
there  is  no  abrasion  of  the  skin. 

XANTHOXYLUM— PRICKLY  ASH. 

Source. — Xanthoxylum  is  a  shrub  growing  in  the  northern, 
middle  and  western  States  of  North  America.  The  bark  is 
the  officinal  portion,  and  is  obtained  in  the  form  of  pieces, 
more  or  less  quilled,  of  one  or  two  lines  in  thickness  and  of  a 


486  DENTAL   MEDICINE. 


whitish  color,  with  an  ash-colored  epidermis.  It  is  quite  ino- 
dorous and  has  a  taste  at  first  sweetish  and  slightly  aromatic 
and  afterwards  bitter  and  acrid. 

Medical  Properties  and  Action. — Xanthoxylum  is  aromatic, 
stimulant  and  sialagogue,  and  when  swallowed  occasions  a 
sense  of  heat  in  the  stomach,  more  or  less  general  arterial 
excitement,  and  a  tendency  to  diaphoresis. 

Therapeutic  Uses. — Xanthoxylum  has  been  administered 
with  considerable  benefit  in  the  chronic  form  of  rheumatism. 

Dose. — Of  powdered  xanthoxylum,  gr.  x  to  5ss,  three  or  four 
times  a  day. 

Dental  Uses. — Xanthoxylum,  in  the  form  of  the  powder,  has 
been  applied  with  success  to  an  aching  pulp  for  the  relief  of 
odontalgia,  and  a  decoction  of  the  bark  is  employed  as  a  wash 
for  foul  ulcers;  in  the  form  of  a  tincture  it  is  efficacious  in  re- 
lieving the  soreness  which  remains  after  the  extirpation  of  the 
dental  pulp;  it  is  applied  on  floss  silk  or  cotton.  In  the 
southern  States  the  Angelica  Tree — Aralia  Spinosa,  sometimes 
called  "  Toothache  Tree,"  is  often  called  prickly-ash,  but  it 
differs  from  xanthoxylum,  although  its  tincture  answers  for 
the  relief  of  odontalgia. 

ZINCI  CHLORIDUM— CHLORIDE  OF  ZINC. 

Forimda. — Zn  Clg. 

Derivation. — Chloride  of  Zinc  is  obtained  by  the  action  of 
hydrochloric  acid  on  granulated  zinc,  the  solution  thus  made 
being  purified  by  a  solution  of  chlorine  and  carbonate  of  zinc, 
when  it  is  evaporated  till  it  assumes  a  solid  form.  It  is  in  the 
form  of  a  white  deliquescent  salt,  freely  soluble  in  water,  alcohol 
and  ether,  as  soft  as  wax,  and  capable  of  being  melted  and 
sublimed  by  heat.  As  it  rapidly  deliquesces  when  exposed  to 
the  air,  it  should  be  kept  in  glass-stoppered  bottles.  It  has  a 
styptic,  metallic  taste,  which  is  very  disagreeable. 

Medical  Properties  and  Action. — Chloride  of  zinc  is  the  most 
active  of  the  zinc  preparations,  being  a  powerful  and  penetrat- 
ing escharotic.  Its  local  action  as  a  caustic  depends  upon  its 
affinity  for  albumen  and  gelatin,  and  when  in  contact  with  living 


CHLORIDE  OF   ZINC.  487 


parts  it  destroys  their  vitality,  and  uniting  with  the  albuminous 
and  gelatinous  matters  present,  forms  an  eschar.  It  is  also  a 
useful  deodorizer  and  disinfectant,  and  largely  diluted  has  been 
employed  as  a  nervine  tonic ;  but  as  the  milder  preparations 
of  zinc  answer  the  same  purpose,  it  is  rarely  employed  inter- 
nally. On  account  of  the  great  afifinity  for  water  and  its  power 
of  combination  with  albumen,  chloride  of  zinc  penetrates  and 
spreads  deeply,  and  produces  an  eschar  which  is  white,  thick 
and  hard.  When  applied  to  malignant  and  indolent  ulcers,  it 
promotes  healthy  granulations,  and  when  topically  applied  it 
not  only  destroys  the  diseased  structure,  but  excites  a  new 
and  healthy  action  in  the  surrounding  parts.  When  employed 
as  a  caustic,  it  does  not  give  rise  to  constitutional  disorder  from 
absorption,  an  effect  which  is  sometimes  caused  by  arsenical 
preparations.  In  over-doses  it  causes  a  burning  pain  in  the 
throat  and  stomach,  nausea,  vomiting,  cold  sweats,  decrease  of 
pulse,  cramps  of  the  limbs,  etc.,  being  a  powerful  irritant  poison. 
The  antidotes  in  poisoning  by  zinc  salts  are  albumen,  carbonate 
of  soda,  magnesia  and  soap. 

Therapeutic  Uses. — Chloride  of  zinc  has  been  employed 
internally  in  chorea,  epilepsy,  neuralgia,  scrofula,  and  com- 
bined with  hydrocyanic  acid  in  facial  neuralgia.  Externally 
it  is  applied  to  malignant  growths,  gonorrhoea,  indolent  ulcers, 
etc.  A  solution  of  the  chloride  of  zinc  is  used  as  an  antiseptic 
and  disinfectant. 

Liquor  Zinci  Chloridi — Solution  of  Chloride  of  Zinc, 
known  as  "Burnett's  Disinfecting  Fluid,"  is  composed  of 
chloride  of  zinc,  gr.  cc,  water,  .5J. 

Dose. — Of  Chloride  of  zinc,  gr.  ss.  or  gr.  j,  or  gr.  ij,  largely 
diluted. 

Dental  Uses. — Chloride  of  zinc  is  a  valuable  agent  in  dental 
practice,  being  employed  as  an  external  application  to  sensitive 
dentine.  As  an  obtunding  agent  a  drop  of  the  deliquescent 
chloride  is  placed  in  contact  with  the  sensitive  dentinal  surface 
(which  has  previously  been  dried  and  is  protected  from  all 
moisture),  and  allowed  to  remain  from  two  to  four  minutes. 
Considerable  pain  follows  the  application  of  the  chloride,  which 


488  DENTAL   MEDICINE. 


is  of  a  steady  continuous  character,  without  the  throbbing 
nature  which  characterizes  the  pain  of  an  irritated  dental  pulp. 
Its  painful  action  may  be  modified  by  bathing  the  sensitive 
surface,  prior  to  the  application  of  the  chloride,  with  chloro- 
form, tincture  of  aconite  or  atropine  solution,  or  a  combination 
made.  When  the  pain  has  subsided  the  excavation  of  the 
cavity  can  be  proceeded  with  until  the  layer  of  dentine  affected 
by  the  chloride  has  been  removed,  when  another  application 
may  be  necessary.  As  it  is  not  absorbed  by  the  dentine  to 
any  great  degree,  its  action  being  superficial,  it  is  not  so 
dangerous  an  agent  as  is  arsenious  acid  when  employed  for 
the  same  purpose. 

In  no  case  should  the  chloride  of  zinc  be  used  as  an 
obtunding  agent,  when  there  is  danger  of  irritating  the  pulp 
of  the  tooth. 

Chloride  of  zinc  applied  to  dentine  as  an  obtunder  of  sensi- 
bility, is  superficial  in  its  action  It  is  also  employed  to 
arrest  superficial  hemorrhage  from  a  wound  of  the  gum  during 
the  filling  of  teeth ;  it  will  also  temporarily  arrest  the  secre- 
tion of  mucus  from  the  surface  of  the  mucous  membrane 
of  the  mouth.  When  applied  to  a  cut  surface  it  induces 
union  by  first  intention,  by  its  effect  upon  the  glutinous 
matter. 

It  has  also  been  successfully  employed  as  an  injection  for 
chronic  alveolar  abscesses,  and  in  the  treatment  of  ulceration 
of  the  gums  attended  with  recession  of  gum  and  absorption  of 
process  from  the  necks  of  teeth  ;  also  as  an  injection  in  disease 
of  the  antrum.  It  has  been  claimed  that  its  application  in  a 
diluted  form  will  promote  the  formation  of  secondary  dentine 
over  a  nearly  exposed  pulp,  but  its  escharotic  action  must 
be  considered  in  using  the  agent  for  such  a  purpose.  When 
applied  to  the  sulcus  which  often  forms  during  ulceration  and 
recession  of  the  gum  from  the  neck  of  a  tooth,  the  application 
can  be  safely  and  conveniently  made  by  means  of  a  camel's 
hair  brush,  or  by  a  piece  of  orange  wood  so  shaped  as  to 
permit  of  its  being  introduced  to  the  bottom  of  such  a  sulcus. 
Chloride  of  zinc  in  a  properly  diluted  form  is    an    efficient 


IODIDE  OF   ZINC.  489 


disinfectant,  and    has  been  employed  for  such  a  purpose    in 
gangrenous  conditions  of  the  mouth. 

Chloride  of  zinc  is  one  of  the  ingredients  of  the  temporary- 
filling  material  composed  of  the  chloride  of  zinc  in  solution 
and  the  oxide  of  zinc,  which  has  been  employed  to  cap  the 
exposed  pulps  of  teeth.  But  owing  to  the  escharotic  action 
of  the  chloride  this  method  has  not  been  uniformly  successful. 
The  zinc  preparations,  however,  answer  good  purposes  as  tem- 
porary filling  materials,  especially  in  sensitive  cavities  where 
the  presence  of  metallic  fillings  would  not  be  tolerated.  (See 
Oxide  of  Zinc.) 

ZINCI  lODIDUM— IODIDE  OF  ZINC. 

Formula. — T^xA^. 

Denvatio7i. — Iodide  of  Zinc  is  obtained  by  digesting  an 
excess  of  zinc  with  iodide  diffused  in  water.  It  is  in  the  form 
of  fine,  white,  deliquescent  needles,  very  soluble  in  water,  and 
of  a  metallic,  styptic  taste,  resembling  that  of  sulphate  of  zinc, 
and  is  very  liable  to  spontaneous  combustion. 

Medical  Properties  and  Action. —  Iodide  of  zinc  is  tonic, 
astringent  and  antispasmodic. 

Therapeutic  Uses. — Iodide  of  zinc  has  been  favorably  em- 
ployed in  chorea,  cachexia,  scrofula  and  hysteria.  It  has  been 
used  for  strumous  inflammations  and  enlargements,  both  ex- 
ternally and  internally.  Externally  it  is  an  efficient  local 
stimulant  and  escharotic,  and  is  considered  to  be  equal,  if  not 
superior,  to  chloride  of  zinc.  In  enlarged  tonsils  it  has  been 
advantageously  employed  in  a  solution  of  IQ  to  30  grains  to 
the  ounce  of  water.  In  the  form  of  an  ointment  composed  of 
a  drachm  of  the  iodide  to  the  ounce  of  lard,  it  has  been  used 
in  the  treatment  of  tumors. 

Dose.—Oi  iodide  of  zinc,  gr,  j,  gradually  increased  to  gr.  vj, 
given  in  the  form  of  syrup. 

Dental  Uses. — Iodide  of  zinc  is  a  valuable  local  application 
in  alveolar  pyorrhoea,  tumors  of  the  mouth,  enlargement  of  the 
tonsils,  etc.  In  alveolar  pyorrhcea  it  is  used  in  connection 
with  peroxide  of  hydrogen,  which  see. 


490  DENTAL   MEDICINE. 


DENTAL  FORMULiE. 

For  Alveolar  Pyorrhea.  For  Alveolar  PyorrhcBa. 

A.  W.  Harlan.  A.  W.  Harlan. 

R.     Zinci  iodi  .    .    .  gr.  xij  to  xxiv.  R.     Zinci  iodi gr.  x; 

Aquse    ....  fgj.  M.  Aquae TTtxc.    M. 

SiGNA. — After  drying  the  gums,  inject  Signa. — Inject   with  a   syringe  if  the 

each    pus-pocket   with   one,   two   or  pockets    are   shallow   without    much 

three  drops  of  this  solution.  carious  process. 

ZINCI  OXIDUM— OXIDE  OF  ZINC. 

Formula. — ZnO. 

Derivation. — Oxide  of  zinc  is  obtained  by  subjecting  pre- 
cipitated carbonate  of  zinc  to  a  red  heat,  till  the  whole  of  the 
carbonic  acid  and  water  are  expelled. 

It  is  in  the  form  of  a  yellowish-white  powder,  insoluble  in 
water,  but  soluble  in  dilute  sulphuric  and  hydrochloric  acids, 
without  effervescence.     It  is  inodorous  and  tasteless. 

Medical  Properties  and  Action. — Oxide  of  zinc  is  tonic  and 
antispasmodic,  but  in  large  doses  causes  vomiting  and  purg- 
ing ;  by  gradually  increasing  the  dose,  large  quantities  can  be 
taken  without  injurious  effects.  It  should  never  be  given  on 
an  empty  stomach,  as  it  may  cause  nausea. 

.Therapeutic  Uses. — It  is  employed  in  spasmodic  asthma, 
convulsions  of  children,  epilepsy,  chorea,  whooping-cough, 
hysteria,  and  is  an  excellent  remedy  for  gastralgia;  also  in 
chronic  diarrhoea  and  chronic  dysentery. 

Dose. — Of  oxide  of  zinc,  gr,  ss  to  gr.  x. 

Dental  Uses. — Oxide  of  zinc  may  be  employed  in  the  treat- 
ment of  convulsions  of  children  during  dentition,  given  in 
doses  of  gr.  ss  to  gr.  v,  gradually  increased  to  gr.  viij,  in  powder, 
with  a  little  sugar.  It  is  also  combined  with  carbolic  acid,  in 
a  fluid  form,  for  capping  exposed  pulps,  being  applied  in  the 
form  of  a  paste  to  the  exposed  surface  of  the  dental  pulp.  It 
also  forms  an  ingredient  of  the  zinc-filling  materials,  and  of 
the  celluloid  base  for  artificial  teeth.  It  is  generally  supposed 
that  alkalies,  especially  ammonia,  have  more  effect  in  disin- 
tegrating oxyphosphate  fillings  in  the  mouth  than  have 
acids 


SULPHATE  OF   ZINC. 


491 


DENTAL    FORMULA. 


Oxyphosphate  of  Zinc   Preparation  for 

Filling  Teeth. 

POWDER. 

R .     Zinci  oxidi partes  200 

Silicii  (fine  powd.)    .    .  partes  viij 

Sodii  boratis partes  iv 

Pulv.  glass partes  v. 

Levigate  under  water,  to  ensure  com- 
plete admixture,  and  dry  by  evaporation ; 
then  calcine  at  a  white  heat ;  then  reduce 
to  powder. 

LIQUID. 

R .     Acidi  phosphoric!, 

Aquae q.s.  to  dissolve, 

and  evaporate  the  solution  by  aid  of 
heat,  until  it  is  of  the  consistence  of 
glycerin. 

Another  Formula  for  the  Oxyphos- 
phate Preparation,  in  which  simply  the 
calcined  oxide  of  zinc  and  glacial  phos- 
phoric acid  are  employed,  is  prepared 
as  follows : — 

Calcine  the  oxide  of  zinc  for  two 
hours,  at  a  white  heat,  or  until  it  be- 
comes a  hard,  yellowish  mass;  then 
pulverize  in  a  mortar,  and  sieve  through 
fine  bolting  cloth.     For  the  liquid  take 


^  j  of  glacial  phosphoric  acid  (German), 
in  crystals,  and  dissolve  in  f  ,^  j  of  water, 
and  then  evaporate  to  one-third,  on  a 
sand  bath. 

Oxychloride   of  Z.inc    Preparation  for 
Filling  Teeth. 

FOR   THE    POWDER. 

R.     Zinci  oxidi gr.xxx. 

Sodii  boratis gr.ij 

Silicii  (finepo-wd.)  .  .  gr.j. 
Mix  thoroughly  and  subject  to  a 
bright-red  heat  in  a  crucible.  Then 
grind  this  frit  to  a  powder,  and  mix  it 
with  three  times  its  weight  of  calcined 
oxide  of  zinc. 

FOR  THE    LIQUID. 

R.     Zinci  chloridi  (deliq.)  .  f^j 

Aquae f^vtovj. 

For  Neuralgia  of  the  Head. 
Von  Niemeyer. 
R ,     Ext,  hyoscyami, 

Zinci  oxidi .  .    .  aii .  .    •  9  ij.     M. 
SiGNA. — Fiat  pill.  xj. 

Begin  with  one  pill  morning  and 
evening,  and  increase  to  xx  or  xxx 
daily. 


ZINCI  SULPHAS— SULPHATE  OF   ZINC. 

Formula. — ZnS047H20. 

Derivation. — Sulphate  of  zinc  is  obtained  by  the  action  of 
sulphuric  acid  on  granulated  zinc,  the  solution  being  purified 
by  means  of  chlorine  and  carbonate  of  zinc,  and  afterwards 
evaporated,  the  product  being  crystals  of  sulphate  of  zinc.  It 
is  in  the  form  of  colorless  crystals,  which  effloresce  on  expos- 
ure to  air,  and  are  soluble  in  water  and  insoluble  in  alcohol, 
resembling  in  appearance  Epsom  salts.  It  has  a  disagreeable, 
metallic,  styptic  taste. 

Medical  Properties  and  Action. — Sulphate  of  zinc  is  tonic, 
astringent,  antispasmodic,  and,  in  large  doses,  emetic.    Exter- 


492  DENTAL   MEDICINE. 


nally,  it  is  stimulant  and  astringent.  When  its  use  is  long 
continued,  It  produces  symptoms  like  those  of  lead.  When 
administered  in  proper  doses,  it  exerts  an  antispasmodic  in- 
fluence on  the  nervous  system,  and  where  there  is  spasm  and 
convulsion,  it  is  very  serviceable. 

Therapeutic  Uses. — It  is  internally  administered  in  epilepsy, 
chorea,  hysteria,  angina  pectoris,  chronic  dysentery,  flatulence, 
night  sweats  of  phthisis,  etc.,  and  is  a  prompt  emetic  in  cases 
of  narcotic  poisoning.  Internally,  it  is  employed  in  the  treat- 
ment of  gonorrhoea  of  the  eye,  chronic  skin  diseases,  epitheli- 
oma, ulcers,  gangrene,  etc. 

Dose. — Of  sulphate  of  zinc,  gr.  %  to  gr.  vi.  For  an  emetic 
in  cases  of  poisoning  six  grains  will  prove  sufficient,  well 
diluted  with  water,  and  repeated  every  fifteen  minutes  until 
em.esis  occurs. 

Dental  Uses. — Sulphate  of  zinc  is  employed  externally  in 
dental  practice,  in  gangrene  of  the  mouth,  disease  of  the  an- 
trum, ulcerations  of  mucous  membrane,  and  indolent  ulcers, 
acting  as  a  stimulant  and  astringent. 

DENTAL    FORMULA. 

For  Gangrene  of  the  Mouth  [^Cancruni  For   Ulceration  of  Mucous  Membrane 

Oris).  of  the  Mouth. 

R .     Zinci  sulphat gr.xx  R .     Zinci  sulphat gr.  j  to  v 

Mellis gj.      M.  AquK  destillate  .    .    .    .  ,^j      M. 

SiGNA — To  be  applied  with  a  camel's  SiGNA. — To   be   used   as   a   gargle   or 

hair  brush.  lotion. 

For  Chronic  Alveolar  Abscesses,  Abscess  of  Antru?n,  etc, 
G.  L.  Parmele. 

R .     Zinci  sulphat gr.iij 

Plumbi  acetatis gr-  v 

Tinct.  catechu gtt.  x 

Aquae f  §j.         M. 

SiGNA. — Use  as  a  stimulating  injection. 

ANTISEPTICS  IN  DENTAL  PRACTICE. 

The  term  antisepsis  implies  the  prevention  of  septic  in- 
fluence or  putrefaction  in  wounds,  and  the  healing  of  wounds 
by  first  intention  or  without  suppuration. 


ANTISEPTICS   IN   DENTAL   PRACTICE.  493 

Antiseptics  are  medicinal  substances  which  possess  the  power 
of  arresting  the  process  of  putrefaction,  and  they  embrace 
such  drugs  as  organic  (vegetable)  acids,  inorganic  (mineral) 
acids,  the  former,  such  as  carbolic,  salicylic  and  benzoic  acids 
being  applicable  to  tooth-structures  and  tooth-tissues;  while 
the  latter,  such  as  nitric,  sulphuric,  hydrochloric,  boracic  and 
chromic  acids  are  restricted  to  the  treatment  of  tooth-tissues  ; 
also,  the  iodides,  which  include  the  tincture  of  iodine,  iodo- 
form, iodol,  potassium  iodide,  aseptol,  aristol ;  also  the  mer- 
curials, such  as  the  bichloride  and  biniodide  of  mercury  ;  also 
such  oxidizing  agents  as  peroxide  of  hydrogen  and  perman- 
ganate of  potash ;  also  the  essential  oils,  such  as  cajuput,  cassia, 
peppermint,  cloves,  thyme,  turpentine,  caraway  mustard, 
eucalyptus,  juniper,  gaultheria,  cinnamon,  eugenol,  sassafras, 
pennyroyal,  valerian,  etc.;  also  the  wood  and  coal-tar 
derivatives,  such  as  creasot,  hydronaphthol,  resorcin,  lysol,  etc.; 
also  heat.  The  methods  of  using  antiseptics  in  dental  prac- 
tice are  by  irrigation,  disinfection,  and  as  antiseptic  dressings. 
Irrigation  consists  in  washing  out  cavities  in  teeth,  appli- 
cations to  inflamed  and  infected  surfaces,  syringing  abscesses, 
and  the  use  of  mouth-washes  or  lotions,  diluted  aqueous 
solutions  of  antiseptic  agents  being  considered  preferable  to 
concentrated  solutions  for  such  purposes. 

Disinfection  consists  in  the  destruction  of  micro-organisms 
and  the  products  of  fermentation  and  putrefaction  in  carious 
cavities,  pulp- canals,  gangrenous  pulps,  etc. 

Antiseptic  dressings  or  applications  are  in  the  form  of 
powders,  solutions,  and  pastes,  or  mixed  with  filling  materials, 
such  as  the  preparations  of  zinc.  When  acids  are  used  as 
antiseptics,  they  must  be  so  diluted  as  to  deprive  them  of  their 
caustic  properties  or  action,  and  the  mercurials,  such  as  the 
bichloride,  must  be  in  such  weak  solutions  as  will  prevent 
toxic  effects  on  the  system.  Different  antiseptics  are  required 
according  to  the  anatomical  structure  of  the  part  on  which 
they  are  to  act,  and  also  its  physical  condition,  as  the  in- 
flammation present  may  be  either  acute,  or  chronic,  or  the 
tissue  be  in  a  septic  or  putrescent   state;    hence,  each  con- 


494  DENTAL   MEDICINE. 


dition  demands  a  particular  class  of  antiseptics.  The  strength 
of  the  anti^septic  employed  will  also  depend  upon  the  con- 
dition of  the  tissue  or  structure  at  the  time  of  application. 
Dr.  W.  D.  Miller  has  established  the  relationship  of  micro- 
organisms to  the  etiology  of  dental  caries,  and  also  shown 
that  all  fermentative  and  putrefactive  processes  of  the  dental 
pulp  and  oral  mucous  membrane  are  conditioned  by  the 
presence  of  living  bacteria.  From  recent  experiments  made 
by  Dr.  Miller  on  the  comparative  value  of  antiseptics  for 
sterilizing  cavities,  etc.,  he  concludes  that  bichloride  of  mer- 
cury, "which  usually  ranks  as  the  king  among  antiseptics,"  and 
gave  uniformly  good  results,  in  one  method  he  employed,  fell 
considerably  short  ^^of  the  striking  action  shown  by  the 
trichloride  of  iodine,  and  he  further  remarks  that  "  we  have 
consequently  reasons  to  hope  that  the  trichloride  of  iodine 
may  prove  a  valuable  remedy  in  the  treatment  of  diseased 
conditions  of  the  teeth  and  mouth,  and  that  the  five  per  cent, 
solution  is  one  of  the  most  active  agents  at  our  demand  for 
disinfecting  carious  dentine.  Of  carbolic  acid,  he  says,  while 
it  is  a  very  active  antiseptic  agent,  it  falls  considerably  behind 
the  bichloride  of  mercury  and  trichloride  of  iodine  in  its 
penetrating  power.  Of  lysol  and  trichlorphenol,  he  says  that 
the  results  were  very  similar  to  those  obtained  by  carbolic 
acid.  Of  peroxide  of  hydrogen,  he  says,  that  although  it  is 
an  excellent  sterilizer  for  thin  layers  of  carious  dentine,  it  fails 
when  applied  to  thicker  ones,  as  antiseptics  applied  to  cavities 
of  decay  on  cotton  naturally  retain  their  power  but  a  few 
hours ;  pledgets  of  cotton  saturated  with  carbolic  acid  and 
placed  in  large  cavities  near  the  gums,  lose  their  antiseptic 
action  in  twenty-four  hours.  Of  chloride  of  zinc,  he  thinks 
that  although  it  penetrates  the  tissue  quite  rapidly,  yet  its 
antiseptic  power  is  inferior  to  that  of  many  other  available  anti- 
septics, and  that  the  pain  attending  its  application  to  the 
nearly  exposed  pulp,  more  than  counterbalances  any  slight 
advantage  it  might  otherwise  have  over  carbolic  acid. 

Hydronaphthol  showed  considerable  penetrating,  antiseptic 
and  consequently  preservative  action.     Iodoform  he  considers 


ANTISEPTICS   IN   DENTAL   PRACTICE.  495 

to  be  one  of  the  most  worthless  antiseptics,  and  that  this  fact 
has  not  been  revealed  long  ago  is  in  part  due  to  the  circum- 
stance that  it  is  nearly  always  employed  in  conjunction  with 
some  other  material,  such  as  carbolic  acid,  oil  of  cloves,  etc. 

The  essential  oils,  pyoktanin,  benzoic  acid,  alcohol,  thymol 
and  resorcin,  all  fell  far  short  of  the  standard  of  efficiency 
maintained  by  other  antiseptics  for  sterilizing  carious  cavities. 
He  found  that  thymol  and  salicylic  acid  manifested  an  evident 
preservative  action  upon  the  dental  pulp,  but  the  effects  were 
confined  to  a  small  portion  of  the  pulp.  Of  the  two,  thymol 
gave  the  better  results.  Of  the  aniline  colors  methyl  violet 
and  methylene  blue,  neither,  he  says,  has  the  slightest  pre- 
servative action,  nor  did  they  penetrate  the  pulps  to  a  depth 
of  more  than  a  quarter  of  an  inch.  Campho-phenique,  he 
says,  appeared  to  penetrate  the  pulp  tissue  about  as  rapidly  as 
carbolic  acid,  and  moderately  hardened  the  tissue,  giving  to  it 
antiseptic  properties  by  the  absorption  of  the  solution,  but  not 
equal  to  that  imparted  by  carbolic  acid  alone. 

The  antiseptics  Dr.  Miller  found  to  be  pre-eminently  active 
in  preventing  decomposition  of  pulp-tissue,  were :  bichloride 
of  mercury,  cyanide  of  mercury  (?),  trichlorphenol,  sulphate 
of  copper,  carbolic  acid,  oil  of  cloves,  chloride  of  zinc, 
campho-phenique  (?),  hydronaphthol  (?). 

Those  of  doubtful  value  :  thymol,  salicylic  acid,  eugenol,  a 
and  d  naphthol,  acetico-tartrate  of  aluminium,  five  per  cent, 
solution  of  bichloride  of  mercury,  and  possibly  some  essential 
oils. 

According  to  Dr.  Black,  "  infectious  matter  contains  living 
particles  that  will  grow  and  reproduce  themselves.  Septic 
matter  may  be  in  solution ;  it  is  poisonous.  It  is  the  product 
of  the  growth  of  micro-organisms,  and  it  is  this  product  of 
the  dentine  that  is  dangerous  in  many  cases,  to  the  exclusion 
of  infectious  matter  ;  for  while  infectious  matter  may  be  in  the 
dentine,  may  live  there  for  a  time,  it  certainly  will  not  live 
there  very  long  if  communication  by  which  it  receives  food  is 
cut  off.  It  must  receive  food  in  any  case,  and  must  get  clear 
of  its   waste   products  or  it  will    soon    be   choked.     Though 


496  DENTAL   MEDICINE. 


microbes  may  not  be  present  in  the  dentine,  there  is  danger  of 
poisoning  from  the  septic  matter  that  is  absorbed,  filling  the 
dentinal  tubules.  We  have  a  different  set  of  conditions  when 
we  leave  a  little  bit  of  softened  dentine  over  a  pulp  nearly  ex- 
posed. We  may  cover  in  the  anaerobic  microbes.  In  a  short 
time  they  produce  products  that  will  destroy  the  pulp,  or  they 
may  pass  through  and  penetrate  into  the  pulp,  and  we  may 
have  an  infected  pulp  presently  from  the  microbes  we  have 
covered  in.  This  action  is  brought  about  rapidly  and  the 
poisonous  matter  escapes  toward  the  pulp.  If  we  have 
covered  them  in  with  the  filling  we  have  sealed  up  the  ele- 
ments for  destroying  that  pulp.  It  is  not  necessary  that  the 
dentine  be  softened  more;  it  may  not  be  a  class  of  microbes  that 
soften  dentine.  It  is  a  microbe  that  attacks  the  sarcous  ele- 
ments of  the  body ;  the  contents  of  the  dentinal  tubes  are 
attacked  just  as  well.  So  here  we  need  a  disinfectant.  What 
shall  we  use  ?  Certainly  not  one  of  the  coagulants  (such  as 
carbolic  acid,  creasote  and  chloride  of  zinc — agents  which  seal 
the  septic  matters  within  the  teeth);  certainly  not  one  that  places 
a  barrier  to  its  own  penetration  by  coagulating  the  albumen. 
These  are  not  the  antiseptics  you  should  use  in  this  place,  but 
something  we  can  depend  upon  to  penetrate  in  the  presence 
of  albumen,  and  we  find  that  to-day  in  the  use  of  the 
essential  oils,  and  among  them  the  oil  of  cassia  is  the  most 
potent.  There  are  many  of  the  essential  oils  that  when  used 
in  substance  will  destroy  microbes  just  as  quickly  as  the  oil 
of  cassia,  and  among  them  may  be  mentioned  the  oil  of 
turpentine,  but  there  is  none  of  them  that  will  destroy 
microbes  so  rapidly  and  so  certainly  with  that  proportion  of 
the  oil  that  will  dissolve  in  water,  or  the  fluid  with  which  they 
come  in  contact  in  their  application  in  practice  as  the  oil  of 
cassia.  In  bacteriology,  the  terms  germ,  bacteria,  microbe^ 
schizomycetes,  are  used  almost  as  synonymous  names,  but 
microbe  seems  preferable  to  germ  or  bacteria,  and  schizomy- 
cetes is  considered  to  be  a  better  scientific  term  than  either. 
It  is  also  conceded  that  these  are  unicellular  and  assimilate 
nourishment  apparently  by  absorption   in  the  media  in  which 


ANTISEPTICS   IN   DENTAL   PRACTICE.  497 

they  live,  but  they  must  alter  their  foods  found  proper,  and 
yet  unfit  in  nature  for  their  use  and  appropriation.  Bacteria 
living  or  dead  matter  encounter  no  living  resistance,  while 
those  feeding  on  living  tissues,  or  fluids  in  living  tissues,  meet 
the  living  cells  of  the  body  and  have  to  combat  them.  The 
diastases  secreted  by  the  various  beings,  whether  highly 
organized,  or  unicellular  and  microscopic,  have  something  in 
common  as  to  their  respective  objects  and  their  properties  of 
transforming  matter.  The  roll  of  microbes  in  existence  is 
complex  and  necessary,  though  some  are  injurious.  They  act 
as  scavenorers,  return  to  the  air  and  water  the  organizable  ele- 
ments  abstracted  daily  by  the  vegetables  and  indirectly  by 
animals,  and  are  indispensable  to  life.  The  bacteria  that  in- 
vade living  organisms  which  happen  to  be  fit  for  their  nourish- 
ment and  growth  are  considered  to  be  parasites.  The  spon- 
taneous generation  of  living  organisms,  no  matter  how  little, 
is  now  regarded  as  a  fallacy. 

Formerly,  when  the  root-canal  of  a  tooth  was  opened  and 
found  to  be  empty  and  dry,  peridental  trouble  resulted.  But 
the  treatment  of  such  cases,  as  now  pursued,  consists  in  ex- 
cluding the  saliva  and  atmospheric  microbes,  the  removal  of 
every  particle  of  debris,  and  the  application  of  antiseptics  and 
disinfectants.  To  render  a  pulp-canal  permanently  aseptic,  it 
should  be  thoroughly  cleansed  with  either  alcohol,  peroxide 
of  hydrogen  or  ammonia,  using  a  syringe  to  prevent  septic 
matter  being  forced  through  the  foramen.  After  the  alcohol 
has  evaporated,  or  the  canal  thoroughly  dried  of  the  peroxide 
of  hydrogen  or  ammonia,  by  means  of  a  hot  air  syringe,  an 
application  of  the  bichloride  of  mercury  or  other  antiseptic  is 
then  made,  and  the  canal  rendered  permanently  aseptic.  In 
an  open  pulp-canal  containing  partly  devitalized  pulp-tissue, 
the  same  care  must  be  exercised  to  cleanse,  disinfect  and 
render  aseptic.  When  alveolar  abscess  exists  as  the  result  of 
a  devitalized  pulp,  similar  treatment  is  indicated;  and  in  all 
cases  where  a  pulp  has  been  destroyed  by  therapeutic  remedies 
or  agents,  the  treatment  consists  in  cleansing,  disinfecting  and 
filling  the  pulp-canals. 
32 


498  DENTAL   MEDICINE. 


Dr.  A.  W.  Harlan  remarks  :  "  All  cavities  in  living  and 
pulpless  teeth  are  infected  through  the  agency  of  pathogenic 
bacteria  or  micrococci.  (Black,  Milles,  and  Underwood  and 
Miller.)  These  micro-organisms  and  other  septic  matters 
cannot  be  destroyed  in  excavating  a  cavity  in  a  living  tooth 
short  of  destruction  of  the  pulp  by  coagulating  drugs  save  in 
rare  instances.  Dilute  solutions  of  bichloride  of  mercury, 
peroxide  of  hydrogen  and  some  of  the  naphthol  compounds, 
belong  to  this  class  ;  coagulators  cannot  be  used  in  a  sufficient- 
ly diluted  state  to  accomplish  disinfection  without  injury  to 
the  parts  to  which  they  are  applied.  Diffusible  drugs  will 
destroy  septic  materials,  including  cause  of  infection,  without 
injury  to  the  living  hard  or  soft  tissues.  The  above  will  apply 
as  well  to  infected  pulpless  teeth,  and  this  is  even  true  with 
reference  to  the  coagulation  of  the  exposed  organic  matrix  in 
the  interior  of  a  tooth  partly  softened  by  caries.  Coagulating 
agents  simply  coagulate  and  leave  the  coagulum  to  become  a 
source  of  food  supply  to  the  aerobic  and  anaerobic  microbes." 

Dr.  Harlan  recommends  the  following  for  softened  dentine  : 
Corrosive  sublimate,  peroxide  of  hydrogen  and  tartaric  acid 
combined,  applied  with  wood  or  platinum  points  ;  then  dry 
the  cavity  and  apply  myrtol  in  full  strength  and  dry  it  again. 
He  also  says  :  If  it  is  deemed  a  necessity  to  apply  an  anti- 
septic agent  to  a  cavity  in  a  tooth  having  a  living  pulp,  an  oil 
(one  of  the  essential  oils,  such  as  peppermint,  camphor,  tur- 
pentine, thyme,  cassia,  cinnamon,  caraway,  eugenol,  cajuput, 
eucalyptol,  terpinol,  myrtol,  sassafras,)  may  be  left  in  contact 
with  the  cavity,  sealed  with  gutta  percha,  or  the  cavity  may 
be  stopped  with  oxysulphate  of  zinc  for  any  number  of  days. 
The  cavity  should  be  well  dried  before  introducing  the  oil.  He 
also  remarks  that  there  is  no  theoretical  objection  to  the  use 
of  carbolic  acid  in  a  living  tooth,  if  it  is  reapplied  from  time  to 
time  perfectly  warmed.  It  should  not  be  used  to  protect  the 
pulp  from  the  invasion  of  micro-organisms  or  deep-seated 
cavities,  as  it  will  prove  inadequate  by  lack  of  diffusibility. 

"  It  is  a  mistaken  idea  to  suppose  that  an  agent  like  carbolic 
acid,  liquefied  or  diluted  with  water,  will  prove  a  permanent 


ANTISEPTICS   IN   DENTAL   PRACTICE.  499 

antiseptic  in  the  presence  of  moisture,  such  as  is  nearly  always 
present  in  a  tooth.  It  does  not  possess  embalming  properties 
because  it  is  easily  absorbed  and  disappears.  It  should  form 
no  part  of  root-filling,  nor  should  it  be  introduced  into  roots 
permanently.  Copal,  Canada  balsam,  or  other  agents  of  this 
class,  may  be  used  on  an  exposed  pulp  in  its  stead,  and  for  in- 
jection into  abscesses,  using  the  root  of  the  tooth  as  a  channel, 
potass-permanganate,  silico-fluoride  of  sodium,  boro-glycerine, 
the  oil  of  cloves,  cassia,  cinnamon,  myrtol,  and  agents  of  this 
class,  are  far  more  powerful,  with  better  stimulating,  antiseptic 
and  disinfectant  properties,  and  they  do  not  possess  the 
coagulating  properties  of  carbolic  acid,  or  its  disagreeable 
odor,  and  under  no  circumstances  will  they  clog  a  delicate 
canal  or  destroy  the  soft  tissue  to  which  they  are  applied. 
Carbolic  acid  should  take  its  legitimate  place  as  a  spray,  a 
local  anaesthetic  and  component  of  mouth-washes  in  dental 
practice,  and  as  an  adjuvant  to  the  oils  where  local  medication 
around  the  roots  of  teeth  may  be  indicated,  or  for  injection 
into  the  antrum  of  Highmore,  combined  with  tannin, 
glycerine,  camphor  or  potash,  or  be  relegated  to  the  labora- 
tory as  a  component  of  sodium  phenate,  or  in  other  chemical 
uses." 

Dr.  W.  D.  Miller,  in  a  recent  article  on  the  disinfection  of 
dental  and  surgical  instruments,  says :  "  There  is  no  depart- 
ment of  surgery  in  which  the  demand  for  antiseptic  procedure 
is  more  urgent  than  in  dentistry,  for  the  reason  that  all  of  our 
operations  are  performed  upon  septic  or  infected  tissues,  and 
we  have  no  means  of  rendering  the  territory  to  be  operated 
upon  aseptic  except  by  the  use  of  antiseptics  of  the  highest 
character.  We  cannot  extract  a  tooth,  cleanse  the  canal  of  a 
pulpless  tooth,  excavate  a  cavity  of  decay  or  lance  the  gums ; 
we  cannot  even  touch  any  point  in  the  oral  cavity  without  our 
instruments  becoming  coated  with  a  layer  of  infectious 
material.  We  are  therefore  bound  to  use  antiseptics,  not  only 
for  the  purpose  of  disinfecting  the  already  infected  tissues,  but 
for  sterilizing  our  instruments  to  avoid  the  transmission  of 
infectious  matter  from  one  patient  to  another."   "  The  necessity 


500  DENTAL   MEDICINE. 


for  absolute  cleanliness  on  the  part  of  the  dentist,  of  his  hands 
as  well  as  of  his  instruments,  napkins,  drinking-glasses,  rub- 
ber-dam, in  short  of  everything  with  which  he  comes  in  con- 
tact with  the  patient's  mouth,  is  universally  recognized  ;  at 
least  there  can  be  no  one  who  has  the  courage  to  express  a 
contrary  opinion."  "  We  can  never  know  what  virus  may  be 
clinging  to  our  instruments,  nor  can  we  with  certainty  predict 
the  result  of  a  wound  upon  the  gums,  cheeks  or  lips  with  an 
unclean  instrument." 

From  Dr.  Miller's  experiments  we  deduct  the  following : 
Boiling  napkins  for  lo  or  15  minutes  in  soap-water  completely 
sterilizes  them.  Small  pieces  of  rubber-dam  can  be  sterilized 
as  a  rule  by  exposing  them  for  30  minutes  to  a  five  per  cent, 
solution  of  carbolic  acid  ;  but  boiling  small  and  large  pieces 
of  the  dam  are  completely  sterilized  by  subjecting  them  to 
boiling  water  for  from  six  to  fifteen  minutes,  according  to 
size. 

Drinking  or  rinsing  glasses  can  be  sterilized  by  boiling  in 
pure  water.  Concerning  instruments,  he  says  :  The  ideal  anti- 
septic is  a  liquid  which  acts  immediately  upon  bacteria  without 
in  any  way  injuring  the  instrument.  His  results  were  as  fol- 
lows :  A  five  per  cent,  solution  of  carbolic  acid  required  one 
hour  to  sterilize  instruments,  and  even  after  such  a  time  the 
result  was  not  certain  ;  and  of  twenty-one  pieces  placed  in 
concentrated  carbolic  acid  for  varying  periods  of  time  rang- 
ing from  one  to  twelve  minutes,  only  two  were  sterilized. 

A  five  per  cent,  solution  of  trichlorphenol  required  an  hour's 
time  to  sterilize.  Lysol  gave  results  nearly  identical  with 
those  of  trichlorphenol.  An  action  of  from  fifteen  to  twenty 
minutes  in  a  five  per  cent,  aqueous  solution  of  the  bichloride 
of  mercuiy  gave  the  most  promising  result  and  can  be  relied 
upon  to  produce  thorough  sterilization ;  but  he  considers  the 
time  required  to  be  so  long  as  to  render  a  five  per  cent, 
solution  of  the  bichloride  of  mercury  unsuitable  for  the  pur- 
pose; besides  the  powerful  action  of  this  agent  upon  steel  or 
iron  is  a  serious  objection  to  its  use  as  a  sterilizer.  A  ten  per 
cent,  solution  of  the  peroxide  of  hydrogen  came  next  to  car- 


TEST-PAPERS   FOR   DENTISTS.  501 

bolic  acid,  but  is  considerably  inferior  to  it.  The  essential  oils 
in  emulsion,  as  well  as  in  pure  form  utterly  failed  to  sterilize- 
A  mixed  antiseptic  solution,  composed  of  a  five  per  cent, 
solution  of  trichlorphenol  in  peroxide  of  hydrogen,  acted 
slightly  more  rapidly  than  the  simple  five  per  cent,  aqueous 
solution  of  trichlorphenol,  but  the  improvement  was  not  en- 
couraging. He  finally  concluded  that  boiling  water  is  far 
superior  to  chemical  antiseptics,  and  all  other  means,  for 
sterilizing  dental  instruments,  and  that  its  easy  application  and 
rapid  action  should  recommend  it  to  every  practicing  dentist 
and  physician.  He  regards  an  exposure  of  three  minutes  to 
boiling  water  sufficient  for  sterilizing  the  smaller  dental  instru- 
ments, and  five  minutes  for  any  other.  The  addition  of  soda 
will  prevent  the  rusting  which  is  liable  to  occur  when  the 
instruments  are  boiled  in  water  alone  ;  hence  a  boiling  solution 
of  carbonate  of  sodium  appears  to  be  the  most  promising, 
Dr.  Miller  recommending  an  exposure  of  three  to  five  minutes 
to  a  boiling  one  or  two  per  cent,  solution  of  soda  for  sterilizing 
dental  and  surgical  instruments.  The  solution  must  not  be 
simply  hot,  but  boiling,  since  the  motion  of  the  boiling  water 
materially  assists  in  rapidly  raising  the  temperature  of  the 
instruments  to  iOO°  C,  and  at  the  same  time  loosens  up  any 
matter  that  may  be  clinging  to  them. 

Incompatible  Antiseptics. — Corrosive  sublimate  and  iodine; 
corrosive  sublimate  and  soap  ;  iodine  and  soap  ;  carbolic  acid 
and  iodine ;  carbolic  acid  and  permanganate  of  potassium  ; 
salicylic  acid  and  soap;  salicylic  acid  and  permanganate  of 
potassium;  permanganate  of  potassium  and  oils  soap,  or 
glycerine;  aristol  and  caustic  alkalies,  ammonia,  mercuric 
chloride,  metallic  oxides,  starch,  or  any  substance  which 
possesses  a  powerful  affinity  for  iodine. 

TEST-PAPERS  FOR  DENTISTS. 

Very  frequently  it  is  important  to  the  dentist  to  know 
whether  his  peroxide  of  hydrogen,  which  is  so  liable  to  change, 
is  still  good  or  has  become  decomposed ;  or  whether  his 
solution  of  bichloride  of  mercury  has   become  inert  by  the 


502  DENTAL   MEDICINE. 


reducing  action  of  organic  matter  in  the  water  under  the  in- 
fluence of  sunlight.  And  so  of  many  other  chemicals  used 
in  the  dental  office  which  are  apt  to  change  in  strength. 

Prof  Chas.  Mayr,  of  Springfield,  Mass.,  has  prepared  a 
series  of  test-papers,  which  will  enable  the  dentist  to  learn 
quickly  and  accurately  whether  his  preparations  are  good  or 
worthless,  and  without  the  use  of  cumbersome  methods. 
They  are  put  up  in  neat  little  books,  each  containing  eight 
different  papers  (of  some,  like  litmus,  several  papers  are  pro- 
vided), affording  sixty-four  different  reactions.  The  papers 
are  as  follows : 

Phenyl-  Caj'binol,  for  strong  acids  and  alkalies. 

Turmeric,  for  alkalies. 

Sulphide,  for  solution  of  metals. 

Potassium  Iodide,  for  H2O2,  bichloride  -^-^. 

Iodide  Starch,  for  hydrogen  peroxide. 

Litmus,  for  weak  acids  and  alkalies. 

Erythroine,  for  salts  and  alkalies. 

Lacmoid,  substitute  for  litmus^  not  affected  by  carbonic 
acid. 

Each  paper  has  printed  upon  it  the  reactions  it  gives, 'so 
that  even  the  inexperienced  have  a  safe  guide  as  to  its  uses. 

NEW  REMEDIES. 

The  following  is  a  list  of  the  new  remedies  more  recently 
introduced,  their  action  and  posology,  which  will  be  found 
useful  as  a  matter  of  reference  : 

Therapeutic   Uses.  Dose. 

Acetanilide Analgesic  and  antipyretic 2  to  5  grs.  per  os. 

Acetylphenylhydrazin  .  Antipyretic  and  analgesic     .    .    .    .  3  to  5  grs.  per  os. 

Agaricine Antisudorific  in  phthisis /4  S^-  per  os. 

Amylene  hydrate  .    .    .  Hypnotic  anodyne ^  gr.  to  I  dr. 

Anthrarobin Against  skin  diseases 

Antipyrine Antifebrile  and  anodyne 15  to  30  grs.  per  os.  or 

subcutaneously. 

Aristol Antiseptic  and  in  skin  diseases    .    . 

Benzoyl-anilide  .  .        .Antipyretic I  )^  to  5  grs.  per  os. 

Benzoylgaiacol  ....  Antituberculotic 4  to  10  grs.  per  os. 

Betol Antigonorrhoic In  bougie. 


NEW   REMEDIES.  503 


Therapeutic  Uses.  Dose. 

Bismuth  salicylate  .  .    .  Against  gastric  affections 6  to  1 5  grs.  per  os. 

Bromofomi Against  pertussis i  to  2  min.  per  os. 

Camphoric  acid  ....  Antisudorific  in  phthisis,  etc.  ...  30  grs.  per  os. 

Cetrarin Stomachic 2  grs.  per  os. 

Chloralamide Hypnotic 30  to  45  grs.  per  os. 

Chloralurethan  ....  Hypnotic 15  to  45  gis.  per  os. 

Creolin Antiseptic 5  min.  internally. 

Ethylenimine  hydrochlo- 
ride   General  stimulant ^  to  "/^  gr.  subcutane- 

ously. 

Exalgine Analgesic 4  grs. 

Guaiacol Antituberculotic I  min.  per  os. 

Hydrastinine Against  uterine  hemorrhage    ...  I  gm.  subcutaneously. 

Hydroxylamine  ....  Against  skin  diseases Externally. 

Hydracetin See  acetylphenylhydrazine  .... 

Hypnone Plypnotic  .  3  to  8  min.  per  os, 

Ichthyol Antirheumatic ;  against  sciatica, 

erysipelas,  skin  diseases  ....  Externally  and  4  to  20 

min.  per  os. 

Iodine  trichloride  .    .    .  Antiseptic Externally  in  i  per 

cent,  of  solution. 

Iodoform  bituminate  .  .  Antiseptic Externally. 

lodol Antiseptic Externally. 

Lanoline As  an  ointment  base  or  vehicle  for 

other  medicaments 

Mercury  phenate  .    .    .  Antisyphilitic K  ^°  /^  S^-  subcutane- 
ously. 

Mercury  peptoglutine.  .  Antisyphilitic j!^  gr.  subcutaneously. 

Mercury  salicylate  .  .    .  Antisyphilitic /^  to  >i  g"".  subcutane- 
ously. 

Mercury  succinimate  .  .  Antisyphilitic 

Methacetin Antipyretic 3  grs.  per  os.  for  child- 
ren. 

Methylal Hypnotic  and  anaesthetic 1 5  to  30  grs.  per  os. 

Methylene  blue  .  .    .    .Analgesic 8  to  15  grs.  per  os. 

Methylene  chloride  .    .  Narcotic  anaesthetic 

Monobromacetanilide  .  Analgesic i  to  8  grs.  per  os. 

Myrtol Antiseptic  in  phthisis 5  min.  per  os. 

Naphthalene Antiseptic 2  to  8  grs.  per  os. 

Naphtholic  acid    .        .  Antiseptic  and  antiparasitic  .... 

Naphthol Antiseptic 

Naphlhol  camphoratum  Antiseptic  antituberculotic  ....  SuI)cutaneously. 

Orexin  hydrochloride     Stomachic ^  grs.  per  os. 

Paraldehyde Hypnotic  and  sedative 15  to  45  min.  per  os. 

I'henacetin Antipyretic,  antincuralgic 8  to  20  grs.  per  os. 


504  DENTAL   MEDICINE. 


Therapeutic  Uses.  Dose. 

Phenylurethan  ....  Antifebrile,  antirheumatic 6  to  8  grs.  per  os. 

Piperazide  hydrochlo- 
ride   General  stimulant Externally. 

Pyoctanin Antiseptic 

Pyridine Antiseptic i  to  i  j^  drs.  by  inhala- 
tion. 

Pyrodin  .......  See  acetylphenylhydrazine  .... 

Resorcin Antiseptic  antifermentative  .... 

Rubidium  ammonium 

bromide Antiepileptic /^  to  i  ^  drs.  per  os. 

Salipyrin Antifebrile,  antirheumatic.  ...       15  grs.  per  os. 

Salol      Antiseptic  antigonorrhoic 15  to  30  grs.  per  os. 

Sodium  theobromine 

salicylate Diuretic 8  to  15  grs  per  os. 

Sodium  anisate  ....  Antipyretic,  antirheumatic  ....  15  grs.  per  os. 

Sodium  dithiosalicylate  Antipyretic,  antirheumatic  ....  3  grs.  per  os. 

Sodium  paracresotate  .  Antipyretic,  antirheimiatic  .    .    .    .  8  to  15  grs.  per  os. 

Somnal Hypnotic 30  min.  per  os. 

Sozoiodol Antiseptic Externally. 

Sulphaminol Antiseptic Externally. 

Sulphonal Hypnotic 15  to  30  grs.  per  os. 

Terpene  hydrate  .    .    .  Against  pulmonary  affections  .    .    .  3  to  16  grs.  per  os. 

Terpinol Against  pulmonary  affections  ...  2  min.  per  os. 

Tetronal Hypnotic 15  to  30  grs.  per  os. 

Thallin  sulphate.  .    .    .  Antigonorrhoic Injection. 

Thiol Ichthyol  substitute  q.  v 

Tribromphenol  ....  Antiseptic Externally. 

Trional Hypnotic 15  to  30  gis.  per  os. 

Thioresorcin Antiseptic 

Urethane Hypnotic 15  to  40  grs.  per  os. 

ERUPTION  OF  THE  TEETH. 

TEMPORARY   TEETH. 
(The  inferior  generally  precede  the  superior  by  two  or  three  months.) 

Central  incisors 5  to  8  months 

Lateral 7  to  10     " 

First  molars 12  to  16     " 

Canines 14  to  20     " 

Second  molars ' 20  to  36     " 

The  following  diagram,  by  Dr.  Louis  Starr,*  shows  the 
grouping,  the  date  of  eruption  and  the  duration  of  the  pauses 
between  the  appearance  of  each  group  of  temporary  teeth. 

*  Diseases  of  the  Digestive  Organs  in  Children,  Philadelphia,  1891. 


ERUPTION  OF  THE  TEETH. 


505 


The  numbers  i  to  5  indicate  the  groups  to  which  the  in- 
dividual teeth  belong  and  their  order  of  appearance,  and  the 
letters  a  and  h  the  precedence  of  eruption  in  the  different 
groups. 


5^ 

3^ 

^ 

^ 

0 

-O 

n 

u  \  p 

^y- 
^ 

a 

4 

% 

h 

V 
1 

V 

1 

3 

4 

EXPLANATION    OF   DIAGRAM. 

1,  I.  Between  the  fourth  and  seventh  months.     Pause  of  3  to  9  weeks. 

2.  2.  2.  2   Between  the  eighth  and  tenth  months.     Pause  of  6  to  1 2  weeks. 

3-  3-  3-  3-  3-  3-  Between  the  twelfth  and  fifteenth  months.     Pause  until  the 
eighteenth  month. 

4,  4.  4.  4.  Between  the  eighteenth  and  twenty-fourth  months.     Pause  of  2  to  3 
months. 

5.  5.  5.  5.  Between  the  twentieth  and  thirtieth  months. 


PERMANENT  TEETH. 

First  molars 5  to  6  years  Second  bicuspids  .  10  to  12  years. 

Central  incisors  ....  6  to  8     "  Canines 11  to  13     " 

Lateral  .......  7  to  9     "  Second  molars  .,  12  to  14     " 

First  bicuspids  .    ,    .    .  9  to  10  "  Third  molars  .  .    .  17  to  21     " 


AUTHORITIES   CONSULTED. 


Pharmacopoeia  of  the  United  States. 

Bartholow's  Materia  Medica  and  Therapeutics. 

United  States  Dispensatory.    . 

Braifhwaite's  Retrospect. 

National  Dispensatory. 

Waring's  Practical  Therapeutics. 

Blakiston's  Physician's  Visiting  List. 

Biddle's  Materia  Medica. 

British  Pharmacopoeia. 

American  Journal  of  Medical  Sciences. 

London  Lancet. 

British  Medical  Journal. 

Medical  and  Surgical  Reporter. 

Stille's  Therapeutics  and  Materia  Medica. 

Taylor  on  Poisons. 

Tanner  on  Poisons. 

Wood's  Therapeutics,  Materia  Medica  and  Toxicology. 

Medical  Record. 

New  York  Medical  Journal. 

Medico-Chirurgical  Transactions. 

Ure's  Dictionary. 

Therapeutic  Handbook  of  the  United  States  Pharmacopoeia. 

Universal  Cyclopaedia — A.  McLane  Hamilton. 

Ellis'  Medical  Formulary. 

Compendium  of  Medical  Science. 

American  Journal  of  Dental  Science. 

Dental  Cosmos. 

Dental  Register. 

Ohio  State  Journal  of  Dental  Science. 

London  Dental  Record. 

British  Journal  of  Dental  Science. 

Garretson's  Oral  Surgery. 

Tanner's  Index  to  Diseases. 

Pareira's  Materia  Medica  and  Therapeutics. 

American  System  of  Dentistry. 

The  Epitome. 

Western  Dental  Joiurnal. 

Items  of  Interest. 

Dental  Advertiser. 

Odontographic  Joiurnal. 

Dental  Review. 

International  Dental  Journal. 

Therapeutic  Gazette. 

Items  of  Interest. 

Merck's  Bulletin. 

Shoemaker's  Materia  Medica  and  Therapeutics. 

Turnbull's  Artificial  Anaesthesia. 


506 


INDKX. 


TO 


DISEASES  AND  DENTAL  FORMULARY. 


A  BXORMAL  Dentition 41 

■^^^     Abnormal  Sensitiveness  of  Dentine 63 

Abraded  Surface  of  Mucous  Membrane  of  Mouth,  173,  186,  195,  203,  255 

257,  398 

Abrasion  of  Teeth 64,  383 

Abrasions  by  Artificial  Dentures 173,  203,  378 

Abscess 44,  46,  47,  208 

of  Antrum 46,  344,  347,  422,  492 

Abscess,  to  abort 208 

Abscess,  Maxillary 47 

Absorption  of  Process  and  Recession  of  Gum 66,  197 

Acidity  and  Pyrosis  263 

Acute  Tonsillitis 1 86 

Alkaline  Gargle 386 

Alveolar  Abscess 44,  325,  352,  356,  364,  374,  417,  429,  478 

Hemorrhage 185,  202,  204,  347,  348,  389,  463 

Pyorrhoea 58,  173,  180,  181,  195,  199,  255,  257,  299,  302,  344 

356,  358,  364.  417.  429.  431,  457.  490 

Ulceration 47 

Analgesic  and  Anodyne 248 

Anaemia 14 

Anaesthetics,  General 122,  208,  225 

Local 122,  207,  225,  273,  276,  277,  284,  288,  289,  297,  316,  390 

459.  483 

Anodyne  Lotion 298 

Antifebrin,  Prescription  for 248 

Antiseptic  Dentifrice 181,  329 

Gargle  or  Mouth  Wash 204,  233,  359,  403,  431,  478 

Lotion  or  Injection 180,  181,  262,  358,  385 

Oils.. 333 

Solution  for  Washing  or  Spraying  Wounds 180,  357 

Aphthae 57,  188,  199,  254,  291,  332,  382,  444,  467,  468,  469 

Aphthous  Ulcerations 173,  199,  352,  353,  467,  469 

Astringent  Dentifrice 203 

Gargle 186,  203,  204,  329,  379 

Lotion,  Gargle  or  Mouth  Wash 186,  203,  204,  257,  379 

Astringent  and  Antiseptic  Gargle 204,  403 

BLACK'S  Antiseptic  Dressing  for  Pulp  Canals  and  Abscesses..  182,  334 
Bleaching  Discolored  Teeth 68,  205,  235,  272,  283,  291,  430,  469 

Kirk's  Method  of. 469 

507 


508         INDEX  TO  DISEASES  AND  DENTAL  FORMULARY. 


Boulton's  Preparation 373 

Bruises , 208,  257 

Burns ,  195 

Burnett's  Disinfecting  Fluid 487 

CANCEROUS  Tumors 53,  57,  157,  242,  401 
Ulceration 57,   168,  401 

Cancrum  Oris 52,  157,  263,  271,  291,  332 

Carbolized  or  Carbolate  of  Potash  for  Alveolar  Pyorrhoea,  etc 179 

Styptic 181 

Caries  of  Maxillary  Bones 191,  199,  279,  332 

Chapped  Hands  and  Lips 173,  274,  438,  482 

Chemical  Bleaching  of  Teeth 68 

Chilblains 181,  200 

Chloroform  Narcosis 200,  245 

Chronic  Abscesses  and  Ulcers 204,  287,  492 

Alveolar  Abscesses,  Ulcerations,  etc 44,  204,  279,  492 

Inflammation  of  Gums  and  Mucous  Membrane 188,  203 

Inflammation  of  Dental  Pulp 62 

Inflammation 30 

Cleft  Palate 55 

Cocaine,  To  make  Solutions  or  Preparations  of. 314,  316,  317 

Convulsions  of  Dentition 42,  277,  490 

■T~\ANGERS  of  Anaesthesia 219,  245 

■*-^     Dental  Caries 70 

Exostosis,  or  Hypercementosis 65 

Dental  Periostitis 43,  89,  208,  278,  279,  321,  372,  374,  402,  438,  445 

456,  465 

Dentifrices 181,  203,  302,  327,  328,  329,  377 

Dentigerous  Cysts 53 

Denudation,  or  Erosion 65 

Deodorizers  of  Iodoform 299,  365  367 

Detergent  Mouth  Wash  or  Gargle 453,  467 

Devitalizing  Pulps  of  Teeth., 163,  167,  168,  169,  367,  398,  478 

Diarrhoea  of  Dentition 42,  199,  263,  363,  422,  442 

Digestive  Stimulation  in  Alveolar  Pyorrhoea 302 

Diphtheritic  Conditions 467 

Discolored  Teeth 66,  68,  205,  235,  272,  283,  291,  430,  469 

Disease  of  Antrum 254 

Diseases  of  Dental  Pulp 62,  63 

Disinfect  Softened  Dentine 359 

Disinfectant  Mouth  Wash  or  Gargle 180,  195,  280,  448 

Disinfectant  for  Carious  Dentine 375,  498 

Dislocation  of  Jaw 54 

Dressing  for  Children's  Teeth 182 

Dry  Mouth i8i 

Dysuria  of  Difficult  Dentition 388 

T^ARACHE  of  Dentition 298 

-*--'     Ecchymosis 257 

Effervescing  Powders 465 

Electro-Magnetism 90 

Emolhent  and  Antiseptic  Gargle 195 


INDEX  TO  DISEASES  AND  DENTAL  FORMULARY.        509 


Enlarged  Glands 368 

Epithelioma 58 

Epulis 57 

Erosion  of  Teeth 65,  383 

Erythema 460 

Excessive  Sweating  of  the  Hands 374 

Exostosis,  Dental 65 

Exposed  Pulps 277,  288,  289,  316,  378,  397,  490 

FACIAL  Neuralgia 207,  259,  390,  398,  441,  484,  485 
Paralysis 56 

Febrile  Excitement  of  Dentition 363 

Fetid  Perspiration 180,  448 

Fetor  of  Breath 272,  291,  328,  448 

Fissured  Tongue 173,  467 

Flagg's  Devitalizing  Mixture 167 

Foul  and  Fetid  Indolent  Ulcers 288 

Fracture  of  Alveolar  Process 49,  486 

of  Jaw 55 

Fungous  Growths  and  Suppurating  Surfaces 63,  374 

GALVANO-CAUTERY 90 
Gangrene  of  Mouth  (Cancrum  Oris) 52,  157,  263,  272,  291,  332 

448,  492 

Garretson's  Devitalizing  Mixture 167 

Gingivitis..   ,., 180,  i8i,   182 

Glycerite  of  Borate  of  Sodium 466 

Glyceritum  Sodii  Boratis 466 

Glycerole  of  Thymol  Preparation 478 

Gutta  Percha  Solution 378 

TT  ARE-LIP 55 

•*^  -^      Harlan's  Devitalizing  Mixtures 168,  169 

Harris"  MouthWash 453 

Hectic  Fever 29 

Hemorrhage  from  Extraction  of  Teeth...  185,  202,  204,  347,  348,  389,  463 

Hemorrhage  from  Lancing  Gums 348 

Herpes  Zoster  of  Mouth  and  Gums. 69 

Hyperaemia 14 

Hypercementosis 65 

Hypersensitive  Dentine 63,  203,  232,  260,  317 

Hypertrophy  of  Gums 58 

of  Processes 64 

of  Tonsils 186 

Hypnotic 288,  290 

IMPACTED  Tooth 54 

■*•     Incompatibility 91 

Indigestion 425 

Indolent  Ulcers  of  Mouth....  I57.  4°' 

Infantile  Bilious  Diarrhoea 387.  422 

Mucous  Diarrhoea 3^7,  422 

Infantile  Paralysis  during  Dentition 67 

Inflamed  and  Ulcerated  Gums 203,  204,  232,  236,  257,  352,  379,  445 


510        INDEX  TO  DISEASES  AND  DENTAL  FORMULARY. 


Inflamed  Fauces  and  Throat 157,  204,  236,  240 

Mucous  Membrane  and  Gums,  156,  186,  203,  204,  232,  236,  240,  254 
257,  287,  352,  374,  379,  402,  435,  438 

Inflammation 14,  49 

of  Gums  after  Extraction  of  Teeth 236,  438,  444 

of  Mouth,  Syphilitic 51 

with  Special  Reference  to  the  Mucous  Membrane  of  the  Mouth..     14 

Inflammatory  Fever 23 

Inhalation  in  Syphihtic  Ulcerations 180 

Injections,  Stimulant  and  Antiseptic 180 

Internal  Astringent  in  Hemorrhagic  Affections  and  Dental  Hemor- 
rhage    186 

Iodoform,  Deodorizing  of  , 367 

lodol.  Topical  Application 369 

Irritation 15 

of  Teething  and  Gums 41,  318 

of  Pulp  of  Tooth 62 

Ischemia 15 

Itching  of  Inflamed  Surfaces 398 

of  the  Skin -. 181 

77'IRK'S  Devitalizing  Mixture 168 

LEAD  Poisoning 49 
Local  Anaesthetics,  207,  225,  273,  276,  277,  284,  288,  289,  297,  298 
316,  317,  390,  459,  483 

Loose  Teeth  and  Inflamed  Gums 203,  277 

Lotion  for  Soft  and  Spongy  Gums,  and  Loose  Teeth..... 203 

MALIGNANT  Ulcerations 53,  58,  168,  242 
Medicated  Filling  Material , 192 

Mercurial  Stomatitis 49,  199,  232,  254,  291,  302,  374,  382,  444,  448 

Micro-organisms,  Effects  of. ...20,     31 

Mild  Detergent  Gargle 453 

Mouth  Wash,  Chapin  A.  Harris 453 

Washes 180,  195,  233,  380,  453 

Mucous  Patches  of  Mouth 458 

NASAL  Polypus 56 
Necrosed  Teeth 66 

Necrosis  of  Alveolar  Process 48,  448 

Necrosis  of  the  Jaws 54>  44^ 

Nervous  Cases 250 

Neuralgia,  207,  208,  259,  277,  284,  289,  297,  298,  317,  350,  364,  366,  367 
411,  441,  456,  491 

from  Dental  Disturbance 259,  350,  456 

in  Superficial  Nerves 259 

Neuralgic  Affections  of  the  Teeth 207,  208,  284,  297,  330 

Odontalgia 317,  330,  350 

New  Remedies,  a  List  of  their  Action  and  Posology 502 

OBTUNDING  Mixtures,  Local  Anaesthetics 207,  273,  400 
Odontalgia,  181,  182,  204,  206,  207,  208,  233,  236,  276,  277,  287,  288 
297,  321,  325,  350,  367,  378,  390,  398,  400,  416,  417,  464 


INDEX  TO  DISEASES  AND  DENTAL  FORMULARY.        511 


Odontomes 65 

Ofifensive  Breath 382,  448 

Ointment  of  Iodoform  and  Eucalyptus 368 

Organic  Defects  of  Structure 65 

Osseous  Tumors  of  the  Jaws 191 

Ossification  of  Pulp 63 

Oxychloride  of  Zinc  Preparations 491 

Oxyphosphate  of  Zinc  Preparations 192,  491 

TDAIN  following  Extraction  of  Teeth 206,  233,  273,  277,  279,  282, 

^  .    ■  .  365-398 

following  Separation  of  Teeth 273 

of  Difficult  IJentition '. 317 

Parasitic  Skin  Diseases 180,  200 

Periodontitis 43,  89,  208,  278,  279,  321,  372,  373,  374,  402,  438,  445 

456,  465 

Perspiration  of  Hands,  etc 195 

Phagedenic  and  Sloughing  Ulcers 382,  401 

Phenol  Sodique  Preparations 464 

Phosphor  Necrosis 48 

Pierce' s  Devitalizing  Mixture 167 

Plethora 14 

Poisons  and  Antidotes 104 

Pulpitis 62,  181,  182,  204,  206,  233,  236,  287,  288,  297,  317,  325,  368 

as  a  Capping  in 368 

Pulpless  Teeth 287,  353,  366,  368,  402 

Pulveris  Effervescentes 465 

Putrescent  Pulps 40,  343,  367,  374,  385,  392,  402,  425,  449,  478 

Pyorrhoea  Alveolaris  (See  Formulce  under  Alveolar  Pyorrhoea) 58 


Q 


UININE,  Disturbance  of  Nervous  System  from 21 


RECESSION  of  Gums 66,  488 

Relaxation  of  Uvula 186 

Relaxed  Condition  of  Mucous  Membrane  of  Mouth  and  Gums 451 

Remove  Rust  on  Instruments ,.,,.. 299 

Rheumatic  Pains,  Bruises,  etc 208 

Riggs'  Disease  (See  Alveolar  Pyorrhoea). 

Ringworm 263 

Robinson  Remedy 179 

Root  Canals  of  Abscessed  Teeth 182,  343,  369,  385 

SALIVARY  Calculus,  after  Removal  of. 203,  435 
Salivation 49.  44^ 

Sandarach  Solution  or  Varnish 46' 

Scrofula 52 

Scorbutic  Gums 157-  '88,  203,  236 

Scurvy 5° 

Sensitive  Dentine 63,  8q,  180,  203,  232,  253,  260,  273,  390,  397,  455 

465,  484,  487 

Sensitiveness  after  Removal  of  Salivary  Calculus ^....  203 

Shellac  Solution  or  Varnish 462 

Skin  Diseases '80,  181 


512         INDEX  TO  DISEASES  AND  DENTAL  FORMULARY. 


Sloughing  and  Ill-conditioned  Ulcers 189 

Soft  and  Spongy  Gums 180,  181,  236,  464 

Softened  Dentine 359,  498 

Sore  Throat 203,  236 

Sore  Mouth  of  Nursing  Women 172 

Sterihzed  Instruments 274,  299 

Stimulant  and  Antiseptic  Mouth  Wash  and  Lotion 180,  181,  380 

and  Antiseptic  Injection 181 

and  Anodyne  Lotion 276 

Stomatitis 50,  171,  199,  232,  254,  291,  332,  478 

Stomatitis  of  Dentition '. 171,  317 

Strength,  to  Support  the 264 

Styptic 253,  321 

Superficial  Inflammation 232 

Suppurating  Pulps  of  Teeth  (See  Putrescent  Pulps) 331,  343,  353 

Wounds 180,  181 

Suppuration 25,  278 

to  Hasten 278 

Syphilitic  Teeth 65 

Ulceration  of  Mucous  Membrane  of  Mouth 51,  181,  183,  236,  444 

TEETH  deficient  in  Lime  Salts 268,  270 
Thrush 56,     57 

To  make  Solutions  of  Cocaine 314,  316 

To  render  the  Hands  Aseptic 299,  430 

Tonic  to  Support  Strength 264 

Tonsillitis 186 

Trigeminal  Neuralgia 207,  208 

Truman's  Devitalizing  Mixture 163 

Tumors  of  Gums 367,  368,  423 

of  Jaws 53,  423 

T  TLCERATED  Gums  and  Mucous  Membrane,  188,  203,  236,  257,  302 
^  325.  352,  374.  382,  445,  492 

Ulceration 30,  236,  254,  352 

Ulceration  and  Abrasion  of  Mouth 203,  302,  352,  445 

Ulceration  of  Mouth  and  Throat 236 

Ulcerous  Stomatitis 51,  203,  332 

Ulcers  of  Mouth,  51,  189,  203,  204,  236,  254,  288,  302,  332,  343,  444,  448 
449,  486 

over  Carious  Bone 191.  332 

Syphihdc 51,  181,  183,  236,  444 

Ulitis  (See  Inflammation  of  Gums,  etc.) 50,  203,  204,  236,  357,  374 

TT-ARNISHES,  Dental 369 

V      Shellac 462 

Sandarach 462 

Venereal  Sore  Mouth  and  Throat 363 

Vomiting  and  Painful  Digesdon  of  Teething  Children 263,  298 

"XTSTARTS,  Condylomata,  etc 195,  363 

*  *       Wash  after  Extraction  of  Teeth 236,  302,  438,  444 

Wounds  and  Ulcers 180,  181,  299,  366,  385,  392,  401 


GENERAL  INDEX. 


PAGE 

ABBREVIATIONS 73 

■^~*-     Abies  Canadensis 435 

Abnormal  Dentition 41 

Sensibility  of  Dentine 63 

Abrasion  of  Teeth 64 

Abscess 28 

Abscess,  Alveolar 44 

of  Antrum 46 

Abscess,  Maxillary 47 

Absolute  Alcohol 230 

Absorbents 141 

Absorption  of  Alveolar  Process     66 

Acacia 155 

Acetate  of  Alumina 236 

of  Ammonia  Solution 238 

of  Lead 436 

of  Morphine 394 

Acetanihde 247 

Acetic  Acid 156 

Acids,  Organic 121 

Acids,  Inorganic 120 

Acidum  Aceticum 156 

Arseniosum 157 

Benzoicum 170 

Boricum 172 

Carbolicum 173 

Chromicum 182 

Cresylicum 183 

Gallicum 184 

Acidum  Hydrobromicum 186 

Hydrochloricum 187 

Muriaticum 187 

Nitricum 188 

Nitricum  Dilutum 189 

Phosphoricum 190 

Salicylicum 193 

Sulphuricum 195 

Sulphuricum  Aromaticum  196 

Sulphurosum 199 

Tannicum 200 

Tartaricum 204 

Trichloroaceticum 479 

33 


PAGE 

Aconite 205 

Aconitine,  Duquesnel's 205 

Aconitum 205 

Action  of  Medicines 13 

Acute  Inflammation  of  Dental 

Pulp 62 

Administration  of  Anaesthetics  212 

vEther 208 

Alcohol 230 

Alkalies  and  Alkahne  Earths..  120 

Alkaloids 151 

Aloe — Aloes 233 

Alteratives 1 34 

Alpha  oxynaphthoic  Acid 402 

Alum 234 

Alumen 234 

Exsiccatum 235 

Aluminae  Acetas 236 

et  Ammonia;  Sulphas 235 

Aluminii  et  Potassii  Sulphas...  235 

Chloridum 282 

Sulphis 237 

Alveolar  Abscess 44 

about  to  Point  Externally..     45 

Alveolar  Pyorrhoea 58 

Alveolar  Ulceration 47 

American  Hellebore 484 

Ammonia 238 

Ammonia  Alum 235 

Aromatic  Spirits  of. 238 

Water 238 

Ammonii  Bromidum 264 

Ammonii  Carbonas 240 

Chloridum 241 

Valerianas 241 

Ammonium 238 

Amyl  Nitris 244 

Amylene 242 

Amylene  Hydrate 243 

Anaemia 14 

Anaesthetics 122 

Administration  of,  etc 212 

513 


514 


GENERAL   INDEX. 


PAGE 

Ansesthetic  Mixture 340 

Analgesics , 141 

Aniline 246 

Animal  Charcoal 279 

Anodynes 141 

Antacids 135 

Antemetics 142 

Anthelmintics 140 

Anthemis 246 

Anthridrotics 142 

Antifebrin 247 

Antikamnia 248 

Antilithics 135 

Antiperiodics 1 42 

Antipyretics 1 42 ,  1 48 

Antipyrine 249 

Antiseptic     Mixtures,    Dr. 

Black's 182 

Antiseptic  and  Styptic  Cotton 

Wool 250 

Antiseptics 142,  492 

Antiseptics,  Forms  of. 143 

Antiseptics  in  Dental  Practice.  492 

Antispasmodics 123 

Aphthse 57 

Apothecaries'  Weight 76 

Approximate  Measurements...     74 

Aqua  Acidi  Carbolici  179 

Aqua  Ammonia 238 

Camphora 275 

Chlori 290 

Cinnamomi 303 

Creasoti 324 

Destillata 251 

Fortis -. 188 

Aralia  Spinosa 486 

Argenti  Nitras 251 

Aristol 254 

Aromatic  Bitters 145 

Spirits  of  Ammonia 238 

Aromatic  Sulphuric  Acid 196 

Arnica 256 

Arsenic,  Tests  for 169 

Arsenious  Acid 157 

Astringents 1 24 

Artificial  Respiration 221 

Atropinge  Sulphas , 258 

Atropine 258 

Aurum  Terchloridum 260 

Avoirdupois  Weight 76 

BACTERIA 20,  31,  496 
Baths 151 

Belladonnae  Folia 261 


PAGE 

Belladonnae  Radix 261 

Benzoate  of  Lithium 383 

Benzoated  Lard 171 

Benzoic  Acid 170 

Benzoic  Sulphide  of  Sodium...  261 
Bert's  Method  of  Administer- 
ing Anaesthetics 218 

Best  Twenty-five  Drugs 103 

Bicarbonate  of  Potassium 440 

of  Sodium 464 

Bichloride  of  Mercury 355 

Bichloride    of    Mercury,   Test 

for 358 

Bichloride  of  Methylene 390 

Biniodide  of  Mercury 355 

Bismuthi  Subnitras 262 

Bleaching    Discolored   Teeth,     68 
430,  469 

Blenorrhetics 133 

Bloodletting,  General  and  Lo- 
cal      84 

Blue  Stone 330 

Mass 361 

Vitriol 330 

Bonvvell's  Anaesthetic  Method.  228 

Boric  Acid 172 

Lint 172 

Ointment 173 

Borate  of  Sodium 466 

Borax 466 

Boro-glyceride 172 

Bromides 264 

Bromide  of  Ammonium 264 

of  Calcium 264 

of  Lithium 265 

of  Sodium 265 

of  Camphor 277 

of  Ethyl.. 337 

of  Potassium 441 

Bromol 266 

Bromo-Phenol 266 

Brucine 410 

Burnett's  Disinfecting  Fluid...  487 
Butyl-Chloral  Hydrate 329 

/^ADMII  Sulphas 266 

^^     Calcii  Bromidum 264 

Calcii  Hypophosphis 267,  433 

Calcii  Lithium 265 

Calcined  Magnesia 386 

Calcium 269 

Calendula 268 

Calisaya  Bark 300 

Calomel 359 


GENERAL  INDEX. 


515 


PAGE 

Calx 269 

Chlorata 27 1 

Campho-Phenique 273 

Camphor 274 

Liniment 275 

Water 275 

Camphora 274 

Alonobromata 277 

Camphorated  Tincture  of  Opi- 
um   421 

Cantharidal  Collodion 319 

Cajuput  Oil 415 

Capsicum 277 

Carbo  Animalis  Purificatus 279 

Ligni    280 

Carbolate  of  Soda 463 

Carbolate  of  Sodium 463 

Carbolated  Cosmoline 482 

CarboHc  Acid 173 

Ointment 176 

Water 179 

Carbolic  Acid,  Synthetic 179 

Carbon  compounds 120 

Carbonate  of  Ammonium 240 

of  Lime 326 

of  Lithium 382 

Caries,  Dental 70 

Carminatives 145 

Carvacrol 280 

Cassia  Bark 302 

Cataplasms  140,  151 

Cathartics 128 

Causes  of  Inflammation 17 

Caustic  Potassa 439 

Caustics 138,   145 

Cauterants 146 

Cautery,  Actual  and  Potential..  138 

Cayenne  Pepper 277 

Cerates 153 

Chalk  Mixture 326 

Chalk,  Prepared 326 

Chamomile 246 

Characteristic    Indications    of 

the  Tongue 71 

Chemical  Bleaching  of  Teeth,     68 

Chinoline 282 

Chloral 284 

Hydras 284 

Chloral-Phenol 287 

Chloraiamide 289 

Chloralum 282 

Chlorate  of  Potassa  Troches...  444 

of  Potassium 443 

Chloride  of  Aluminium 282 


Chloride  of  Ammonium 241 

of  Iron 346 

of  Lime 271 

of  Methyl 283 

of  Magnesium 283 

of  Zinc 486 

of  Zinc  Solution 487 

of  Tin 283 

Chlorinated  Lime — Chloride  of 

Lime 271 

Chlorine 290 

Water 290 

Chlorinium 290 

Chloroform 291 

Chloroform-Cocaine  Narcosis..  296 
Chloroform-Morphia  Narcosis,  296 

Chloroformum 291 

Purificatum 291 

Chloro-Percha 378 

Chromic  Acid 182 

Chronic  Inflammation 30 

Chronic  Inflammation  of  Den- 
tal Pulp 62 

Cinchona   Flava,  Pallida  and 

Rubra... 300 

Cinnabar 362 

Cinnamomum 302 

Cinnamon 302 

Oil 303 

Water 303 

Citrate  of  Lithium 383 

Classification      of      Medicinal 

Substances 121 

Cleft  Palate 55 

Chnical  Thermometer 1 15 

Clysters 152 

Cobalt 169 

Cocaine 304 

Dangers  of 315 

Cocaine  Hydrochlorate 305 

Oleate 305 

Citrate 305 

Hydrobromate 305 

-Chloroform  Mixture 296 

-Chloroform  Narcosis 296 

Incompatibles 316 

Poisoning  Treatment  of..,  316 

Cod-liver  Oil 418 

Colchicum 318 

Collodion 319 

CoUodium 319 

cum  Cantharide 319 

Flexile 319 

lodidum 320 


516 


GENERAL   INDEX. 


Collyria 151 

Compound  Syrup  of  the  Phos- 
phates   432 

Compound  Tincture  of  Iodine..  371 

Coloring  Agents 141 

Colorless  Tincture  of  Iodine...  371 

Condy's  Fluid 448 

Confections 151 

Conium 321 

Constringents .-. .   146 

Convulsions  of  Dentition 41 

Corrosive  Chloride  of  Mercury  355 

Sublimate 355 

Cosmoline 481 

Counter-irritants .■•.83,   146 

Creasote 322 

Ointment 324 

Water 324 

Solidified 324 

Creasotum ,  322 

Creolin 298 

Cresylic  Acid 183 

Creta  Prseparata 326 

Croton-Chloral  Hydrate 329 

Cupping 85 

Cupri  Sulphas 330 

DANGERS  of  Anaesthesia...  219 
Deadly  Nightshade 261 

Decimal   System    of  Weights 

and  Measures 76 

Decoction  of  White  Oak  Bark  452 

Decoctions 152 

Decoctum  Quercus  Albse 452 

Definition  of  Subjects  Mate- 
ria Medica  and  Thera- 
peutics      13 

of  various  Classes  of  Rem- 
edial Agents 121 

Demulcents 1 39 

Dental  Caries 70 

Exostosis 65 

Materia  Medica  and  Ther- 
apeutics     155 

Periostitis 43 

Dentifrices 203,  261,  281,  322 

Dentigerous  Cyst 53 

Deodorized  Tincture  of  Opium  422 

Deodorizers 146 

Desiccatives 1 46 

Detergents 1 46 

Devitalizing  Pulps  of  Teeth....   162 

Dialysed  Iron 344 

Diaphoretics 131 


Diarrhoea  Infantile  Bilious 387 

Diarrhoea  Infantile  Mucous  ...   387 

Dichloride  of  Ethidene 336 

Digestibility  of  Foods ■. ..     71 

Diluents .,- 146 

Diluted  Solution  of  Subacetate 

of  Lead 438 

Dimethyloxyquinizine 249 

Discutients 146 

Disinfectants 1 47 

Disinfecting  Instruments 499 

Dislocation  of  Lower  Jaw 54 

Distilled  Water 251 

Dithymol  Diodide  or  Biniodide  254 

Diuretics 132 

Doses  of  Medicines,  Table  of...     93 

Dover's  Powder 421 

Dr.  Black's  Antiseptic  Mixtures 

182,  334 

Drastics 130 

Dried  Alum 235 

■pCCRITICS 121 

-*--^     Effervescing  Powders 465 

Electricity  for  Relieving  Pain  of 

Extraction  of  Teeth. .90,  226 

Methods  of  Applying 226 

as  a  Therapeutic  Means 

in  Treatment  of  Disease     85 

Electrolysis 89 

Electrolysis  for  sensitive  Den- 
tine and  Periodontitis 89 

Electro-Magnetism  for  Extrac- 
tion of  Teeth 90,  226 

Electuaries 151 

Elementary  Substances,  Table 

of 116 

EHxir  of  Vitriol 196 

of  Vitriol  and  Tannin......  202 

Emetics 126 

Emmenagogues ".  133 

Emollients    140,  147 

Emulsions 152 

Enemata 131,   152 

Endermic  Method 82 

Epispastics , 137 

Epithelioma 58 

Epsom  Salt 387 

Epulis 57 

Equivalents 79 

Ergot 332 

Erosion  of  Teeth 65 

Errhines 147 

Eruption  of  the  Teeth 504 


GENERAL   INDEX. 


517 


PAGE 

Escharotics 138,   147 

Essential  Oils 333 

Ether 208 

Ethidene  Dichloridum 336 

Ethyl  Bromidum 337 

Eucalyptol 341 

Eucalyptus 341 

Eugenic  Acid 417 

Eugenol 417 

Evacuants 148 

Excitants 148 

Exostosis,  Dental 65 

Expectorants 147 

Extracts 152 

Extractum  Gelsemii  Fluidum..  349 

Krameriae 380 

Exudation 24 

T^ACIAL  Neuralgia 330 

-^       Facial  Paralysis 56 

Febrifuges 1 48 

Ferri  Chloridum 346 

Ferrum 344 

Dialysatum 345 

Reductum 346 

Fever  of  Inflammation 23 

Fineness  of  Powder 75 

Fomentations 152 

Formsof  Antiseptics  for  Use  143,492 
Forms  of  Medicinal  Substances  151 
Fracture  of  Alveolar  Process. . .     49 

of  Lower  Jaw 55 

French    Decimal    System     of 

Weights  and  Measures 76 

Fused  Potassa 439 

Fungous  Growth  of  Pulp 63 

Fumigations 152 

GALLIC  Acid 184 
Galls 184 

Galvano-Cautery 90 

Gangrene 32 

Gargles 152 

Galvanism 88 

Gelsemium 348 

Germicides 148 

Glacial  Acetic  Acid 157 

Glacial  Phosphoric  Acid 191 

Gleditschi  ne 470 

Glycerin 350 

Glycerinum 350 

Boracis 466 

Pepsini 425 

Glycerite  of  Borate  of  Sodium..  466 


PAGE 

Glycerite  of  Carbohc  Acid 176 

of  Gallic  Acid 185 

of  Tannic  Acid 203 

Glycerites 152,  351 

Glyceritum  Acidi  Carbolici 176 

Acidi  Galhci 184 

Acidi  Tannici 203 

Sodii  Boratis 466 

Gingivitis 50 

Glacial  Acetic  Acid 157 

Glyceroborate  of  Calcium 353 

of  Sodium 353 

Glycerole  of  Thymol 477,  478 

Granulation  25 

Green  Iodide  of  Mercury 362 

Gum  Arabic 155 

Guiacol 325 

Gutta  Percha .  ..  377 

TJyEMATINICS 134 

-*■-'■      Hasmetics 121 

Haemostatics 148 

Hamamelis 353 

Hare  Lip 55 

Harlan's  Method  of  Treating 

Alveolar  Pyorrhoea 429 

Hall's  (Marshall)  Ready  Meth- 
od in  Asphyxia 222 

Hectic  Fever 29 

Hemorrhage  following  the  Ex- 
traction of  Teeth 347 

Hemlock 321 

Herbst's  Obtundent 312 

Herpes  Zoster  of  Mouth  and 

Gums 69 

Hill's  Stopping 378 

Hoffman's  Anodyne 209 

Honey  of  Borate  of  Sodium...  466 
Howard's  Method  of  Artificial 
Respiration  and  Resus- 
citation   223 

Hirudo 84 

Hyderabad     Commission     on 

Chloroform 293 

Hydrargyri  Chloridum  Corrosi- 

vum 355 

Chloridum  Mite 359 

Hydrargyri     Sulphidum      Ru- 

brum 362 

Hydrargyrum 354 

cum  Crcta 361 

lodidum  Viride 362 

lodidum  Rubrum 362 

Sulphidum   Rubrum 362 


518 


GENERAL  INDEX. 


PAGE 

Hydragogues... 128 

Hydrate  of  Aniylene 243 

of  Chloral 284 

of  Potash , 439 

Hydrochlorate  of  Ammonia...  241 

of  Morphine 394 

Hydrochloric  Acid 187 

Hydrobromic  Acid 186 

Hydrobromic  Ether 337 

Hydrogen  Peroxide 426 

Hydronaphthol 402 

Hyperaemia 14 

Hypercementosis 65 

Hypersensitive  Dentine 63 

Hypersthenics 148 

Hypertrophy  of  Alveolar  Pro- 
cesses.       64 

of  Gums 58 

Hypnotics 121,  148 

Hypodermic  Method 82 

Hypophosphites 432 

Hypophosphite  of  Lime 267 

of  Quinine 455 

of  Sodium 433 

IMPACTED  TOOTH 54 

^     Important  Points  in  Diag- 
nosing Affections  of  the 

Mouth 41 

Incompatible  Antiseptics 501 

Incompatibility , 91 

Infantile  Paralysis  during  Den- 
tition   67 

Inflammation  with,  special  Ref- 
erence to   the    Mucous 

Membrane  of  the  Mouth  14 

of   Peridental   Membrane  43 

of  Dental  Pulp 62 

of  Mucous   Membrane  of 

the  Mouth,  Syphihtic...  51 

Inhalants 152 

Inj  ections 152 

Infusions 152 

Infusum  Capsici 278 

Ingluvin , 426 

Inorganic  Materia  Medica 120 

Iodide  of  Potassium 370 

of  Zinc 489 

Iodine 369 

Iodine  Tri-chloride 375 

lodophenacetin 376 

lodophenin 376 

Iodized  Collodion 321 

Iodoform 363 


PAGE 

lodoformum 363 

lodol 368 

lodum 369 

Iridis  Rhizome 370 

Iron  and  Preparations 344 

Irritants 136 

Irritation , 15 

of  Dental  Pulp 62 

of  Teething 41 

Ischsemia 15 

Isonandra  Gutta 377 

Issues  and  Setons 139 

TABORANDI 433 

J      Jamaica  Dogwood 435 

Japanese  Camphor 389 

KANDOL 379 
Kino 382 

Kirk's  Bleaching  Method 469 

Krameria 379 

T   ABARRAQUE'S    Solution  381 

-^     Lacmus 383 

Lacto-Phosphate  of  Lime  Syrup 

270 

Lanolin 380 

Laudanum 421 

Laughing  Gas 403 

Laxatives 1 30,  1 48 

Lead  Poisoning , 49 

Water 438 

Leeches 84 

Lenitives 1 39 

Leopard's  Bane 256 

Lime , 269 

Liniment 270 

Water 269 

Linirnents 152 

Linimentum  Calcis 270 

Camphorge 275 

Saponis 275 

Terebinthinae 476 

Liquefied  Nitrous  Oxide ,..  405 

Liquor  Ammonii  Acetatis.......  239 

Calcis 269 

Ferri  Perchloi'idi 346 

Ferri  Subsulphatis 346 

Gutta  Percha 378 

Plumbi  Subacetatis  Dilu- 

tus 438 

Potassii  Arsenitis 161 

Sodce  Chloratae 381 

Potassii  Permanganatis  ...  448 


GENERAL  INDEX. 


0l9 


PAGE 

Liquor  Zinci  Chloridi 487 

Listerian  Method 144 

Listerine 171 

Lithium 382 

Lithii  Benzoas 383 

Lithii  Bromidum 265 

Lithii  Carbonas 382 

Lithii  Citras 383 

Lithii  Sahcylas 383 

Lithontriptics h 135 

Litmus 383 

Local  Anaesthesia 225,  311 

Bloodletting 84 

Lotions  152 

Lunar  Caustic 251 

Lysol 384 

JY/TAGNESIA 386 

^^^     Magnesii  Chloridum 283 

Magnesii  Sulphas 387 

Marigold 268 

Marshall  Hall's  Ready  Method  222 

Matico 388 

Maxillary  Abscess 47 

May  Apple 438 

Measurement     of     Medicinal 

Substances 74 

Meadow  Saffron 318 

Medicated    Oxyphosphate     of 

Zinc  fillings 192 

Menthol 389 

Mel  Boracis 466 

Sodii  Boracis 173 

Mercury 354 

with  Chalk 361 

Bichloride  of. 355 

Mercurial  Ointment 361 

Poisoning 49 

Mercuric  Chloride 355 

Mercurous  Chloride 359 

Methyl  Chloride 283 

Methyl  Ether 392 

Methyl-I-Lthylic  Ether 392 

Methyl-Violet 247,  449 

Methylene 390 

Methyleneblue 247 

Metric  System  of  Weights  and 

Measures 76 

Microcidin  392 

Micro-Organisms 20,  31,  496 

Mild  Chloride  of  Mercury 359 

Mistura  Cretae 326 

Mixed     Chloroform     Morphia 

Narcosis 296 


PAGE 

Mixtures 153 

Monobromated  Camphor 277 

Monsel's  Solution  and  Powder 

346,  347 

Morphina 393 

Morphinse  Acetas 394 

Hydrochloras  or  Murias.,.  394 

Sulphas 394 

Morphine 393 

Narcosis 296 

Muriate  of  Ammonia 241 

of  Morphine 394 

Muriatic  Acid 187 

Myrrh 398 

M  yrrha 398 

Myrtle  Oil 400 

Myrtol 400 

IVTAPHTHALIN 400 

-'■^      NapeUine   205 

Naphthalene 400 

Naphthol 401 

Narcotics 121 

Nasal   Polypus 56 

Natural  Distribution  of  Remed- 
ies   120 

Nausea  from  Impression  Tak- 
ing    276 

Nauseants 128 

Necrosed  Teeth 66 

Necrosis  of  Alveolar  Process..    48 

of  Jaw 54. 

Nelaton's  Method  of  Resusci- 
tation    221 

Nervines 149 

Neurotics I2i 

New    Remedies.     A    List   of, 
Their  action  and  Posol- 

ogy 502 

Nitrate  of  Ammonia 403 

of  Potassium 445 

of  Silver 251 

Nitre  445 

Nitric  Acid 188 

Nitrite  of  Amyl 244 

Nitrous  Oxide 403 

Nitrous  Oxide,  Action  and  Ad- 
ministration of. 407,  408 

Nitrous  Powders 446 

Non-metals 

Nutritives 149 

Nux  Vomica 410 


520 


GENERAL   INDEX. 


PAGE 

OBTUNDING    Mixtures, 

Use  of....^. 227 

Odontomes 65 

Oil  of  Cassia 303 

of  Cajuput 415 

of  Camphor 276 

of  Cinnamon 303 

of  Cloves 416 

of  Peppermint 390 

of  Pyrethrum 451 

of  Sanitas 476 

of  Sweet  Almonds 415 

of  Turpentine 476 

of  Vitriol 195 

Oils,  Essential 333 

Ointment  of  Carbolic  Acid....  176 

of  Creasote 324 

of  Galls 185 

of  Tannic  Acid 202,  203 

of  Vaseline 483 

of  Veratrine 483 

Ointments 153 

Oleate  of  Aluminum 413 

of  Arsenic  414 

of  Bismuth 413 

of  Cadmium 414 

of  Cocaine 317 

of  Copper 414 

of  Lead 413 

of  Mercury 412 

of  Nickel 414 

of  Silver 414 

of  Zinc 413 

Oleates,  Medicinal 153,  411 

Oleum  Amygdalce  Dulcis 451 

Cajuputi 415 

Camphoras 276 

Caryophilli 416 

Cinnamomi 303 

Eucalypti 341 

Morrhuae 418 

Sanitas 476 

Terebinthinae 47  5 

Opium 419 

Organic  Defects  of  Structure...  65 

Organic  Materia  Medica 121 

Orris  Rhizome 376 

Root 376 

Ossification  of  Dental  Pulp....  63 

Oxide  of  Potassium 439 

of  Zinc 490 

Oxyphosphate  of  Zinc  Filling 

Material 192,  491 

of  Zinc  Filling  Medicated.  192 


PAGE 

Oxychloride    of    Zinc    Filling 

Material 491 

"DAPAIN  or  Papaiva 422 

-^       Paraacetphenitidine 431 

Paralysis,  Infantile 67 

Paraldehyde 423 

Paregoric  Elixir 421 

Pellitory 450 

Peppermint  Cam,phor 389 

Pepsin 424 

Pepsinum 424 

Saccharatum 424 

Perchloride  of  Iron 346 

Periodontitis 43 

Permanganate  of  Potassium....  446 

Peroxide  of  Hydrogen 426 

Peroxide   of    Hydrogen,   Test 

for 428 

Peruvian  Bark 300 

Petrolatum 481 

Petroleum  Ointment 481 

Phenacetine , 43 1 

Phenate  of  Sodium 463 

Phenic  Acid 173 

Phenol 173 

Phenol-Camphor 276 

Phenol  Sodique 179,  463,  464 

Phenylic  Alcohol 173 

Phosphate  of  Lime 433 

of  Sodium 432 

Phosphates 432 

Phosphites 432 

Phosphorus 432 

Phosphor  Necrosis 48 

Phosphoric  Acid 190 

in  the  Anhydrous  State  ...   191 

Pills 153 

Pilocarpus 433 

Pinus  Canadensis 435 

Piscidia  Erythrina.... 435 

Pix  Canadensis 435 

Plasters 153 

Plethora 14 

Plumbi  Acetas 436 

Podophyllum 438 

Poisons 104 

Symptoms  and  Antidotes 

for,  Acid,  Mineral 104 

Aconite 105 

Alkahes 105 

Antimony .   105 

Arsenious  Acid 105 

Argenti  Nitras 105 


GENERAL   INDEX. 


521 


Poisons  Atropine io6 

Belladonna lo6 

Cannabis  Indica io6 

Cantharides 1 06 

Carbolic  Acid 106 

Chloral 107 

Chlorine  Water 106 

Chloroform 107 

Cocaine 315,  316 

Conium 107 

Copper,  Sulphate  of 108 

Corrosive  Sublimate 107 

Creasote 108,  323 

Croton  Oil 108 

Digitalis 108 

Hydrocyanic  Acid 108 

Hyoscyamus 108 

Iodine 109 

Lead  Salts 109 

Mercury 109 

Morphine 109 

Nux  Vomica 109 

Opium 109 

Oxahc  Acid no 

Phosphorus 1 10 

Potash  and  Soda  Salts no 

Silver,  Nitrate  of 105 

Stramonium no 

Strychnine no 

Tobacco no 

Zinc  Salts no 

Poke  Root 484 

Posological  Tables 93 

Potassa  Alum 235 

Caustica 439 

cum  Calce 440 

Potassii  Bicarbonas .  440 

Potassii  Bromidum 441 

Chloras , ..  ...  443 

lodidum 370 

Nitras 445 

Permanganas 446 

Poultices 140,   153 

Pulpitis  62 

Powdered  Subsulphate  of  Iron  347 

Precipitated  Chalk 326 

Prepared  Chalk 326 

Preventive    Measures   against 

Dangers  of  Anaesthesia.  220 

Prickly  Ash 485 

Prince's    Method   of  Treating 

Alveolar  Abscess 429 

Protecti  ves 1 39 

Protiodide  of  Mercury 362 


PAGE 

Protoxide  of  Nitrogen. 403 

Prunus  Yirginiana 449 

Pulse,  the ni 

Variations  in.  Frequency 

of. n2 

Pulvis  Ferri  Subsulphatis 347 

Ipecac  et  opii 421 

Purgatives 1 30,   1 49 

Purified  Animal  Charcoal 279 

Pus 26 

Pyoktanin 449 

Pyorrhoea,  Alveolar 58 

Pyrethrum 450 

QUERCUS  Alba 451 
Quicksilver 354 

Ouillaia  Bark 452 

Ouillaya  Saponaria 452 

Ouininae 300,  453 

Hypophosphis 455 

Sulphas 300 

Quinine 300,  453 

Quinoline 282 

RAPID  Breathing  as  a  Pain 
Obtunder 228 

Refrigerants 1 49 

Recession  of  Gums 66 

Red  Sulphuret  of  Mercury 362 

Relaxed  Condition  of  mucous 

Membrane  and  Gums 451 

Reduced  Iron 346 

Remedies,    Natural    Distribu- 
tion of 502 

Resolvents 150 

Resorcin 456 

Respiration  at  Various  Ages...    1 14 

Restoratives 150 

Resuscitation,  Methods  of. 222 

Rhatany 379 

Rheum 458 

Rhigolene 459 

Rhubarb 458 

Riggs'  Disease 58 

Robinson  Remedy 179 

Rubefacients 136 

Rules  for  Administering  Anics- 

thetics 212 

for  Regulating  Doses 80 

SACCHARATED  Pepsin....  424 
Sal  Ammoniac 241 

Salicylic  Acid ..   193 

Salicyl  Resorcin  Ketone 457 


522 


GENERAL   INDEX. 


PAGE 

Salicylate  of  Lithium 383 

Salicylate  of  Sodium 468 

Salipyrine 194 

Salivation 49 

Salol 459 

Saltpetre 445 

Sandaraca 460 

Sandarach  460 

Sanitas 476 

Scarifications.. 85 

Scurvy 5° 

Scrofula , 52 

Sedatives 126 

Sensitive  Dentine 63 

Serpentaria 46 1 

Sesquicarbonate  of  Sodium 464 

Setons  and  Issues 83,  139 

Shellac 462 

Sialagogues 150 

Soap  Liniment 275 

Sodas  Phenas 463 

Sodii  Bicarbonas 464 

Boras 466 

Bromidum 265 

Sodii  Hypophosphis 433 

Pyrophosphas  433 

Phosphas 432 

Salicylas 468 

Sulphis 468 

Sodium  Silico-Fluoride 470 

Solubility     of     Chemicals     in 

Water  and  Alcohol 117 

Solution  of  Acetate  of  Ammo- 
nia  -, 239 

of  Chlorinated  Soda 381 

of  Chloride  of  Zinc 487 

of  Gutta  Percha 378 

of  Permanganate  of  Potas- 
sium   448 

of  Subsulphate  of  Iron...  346 

Soporifics  121 

S.  Am.  Soap  Tree  Bark 452 

Spastics 126 

Spirit  of  Chloroform 296 

of  Cinnamon 303 

of  Nitrous  Ether 209 

of  Mindererus 239 

Spinants  126 

Spiritus  Ammonise  Aromaticus  238 
Spiritus  ^theris  Compositus...  209 

^theris  Nitrosi 209 

Camphorae 275 

Chloroformi  296 

Cinnamomi 303 


PAGE 

Stannum  Chloridum 283 

Stenocarpine  470 

Sterilizing  Instruments 499 

Stimulants 125 

Stomachics 125 

Stomatitis  5° 

Gangrenous $2 

Ulcerous  5^ 

Mercurial 49 

Syphilitic 51 

Strychnine 410 

Strychninee  Sulphas 410 

Styptic  Colloid 202 

Cotton  202,  251 

Styptics 150 

Subnitrate  of  Bismuth 262 

Subsulphate  of  Iron 347 

Sugar  of  Lead 436 

Sudorifics  131 

Sulfanol 471 

Sulphate  of  Atropine 258 

of  Cadmium 266 

of  Copper 330 

of  Magnesium 387 

of  Morphine 395 

Sulphate  of  Quinine 300 

of  Strychnine 410 

of  Zinc 491 

Sulphate  of  Aluminium 2^7 

of  Lime 433 

Sulphite  of  Soda 468 

Sulpho-Carbolates  of  Zinc,  So- 
dium, Potassium,  Mag- 
nesium,    Calcium    and 

Quinine 177 

Sulpho-Carbohc  Acid 176 

Sulfonal 471 

Sulphonal 471 

Sulphuric  Acid 195 

Ether 208 

Sulphurous  Acid 199 

Suppositories 154 

Suppurants 138 

Suppurating  Teeth 331 

Suppuration 25 

Sylvester's  Method  of  Resusci- 
tation   221 

Symptoms  of  Inflammation..  16,     21 
Synopsis  of  Treatment  of  Af- 
fections of  the  Mouth...     41 

Synthetic  Carbolic  Acid 179 

Syphilitic  Inflammation  of  the 

Mouth 51 

Teeth 65 


GENERAL  INDEX. 


523 


PAGE 

Syrup    of   Lacto-Phosphate  of 

Lime 270,  432 

Syrups 154 

Syrupus  Calcii  Lacto-phospha- 

tis 270,432 

Hypophosphitum 433 

'T^ABLE  of  Doses   of  Medi- 

-'■  cines 93 

of  Equivalents 79 

Tannic  Acid 200 

Tartaric  Acid 204 

Tartrate  of  Chinoline 282 

Terchloride  of  Gold 260 

of  Phenol 473 

Terebinthina 475 

Terebinthene,  Terpine,  Terpi- 

nol,  Terebene 476 

Teriodide  of  Formyl 363 

Terminations  of  Inflammation     32 

Test  Papers  for  Dentists 501 

Tests  for  Arsenic 169 

Tetraiodopyrrol 368 

Thermometers 1 14 

Thiersch's  Method  of  Morphia 

Narcosis 296 

Thrush 56 

Thymol 476 

Tinctura  Aconiti 206 

Arnica 257 

Calendula 268 

Capsici  278 

Eucalypti 342 

Gelsemii 349 

lodi  371 

lodi  Composita  371 

Krameriae 380 

M y rrhae 399 

Opii  421 

Opii  Camphorata 421 

Opii  Deodorata 422 

Pyrethri 451 

Tinctures 154 

Tonics 123 

Topical  Remedies 82,  121 

Treatmentof  Dangerous  Symp- 
toms of  Anaesthesia 220 

of  Inflammation 33 

Trichloride  of  Iodine 375 

Tri-Iirom-Phenol 266 

Trichlorphen ol 479 

Trichloroacetic  Acid 479 

Troches  of  Chloride  of  Potas- 
sium   444 


PAGR 

Troy  Weight 76 

Tumor     of    Jaws,    Malignant 

Form  of. 52 

of  Upper  Jaws 52 

Turpentine 475 

Turpentine  as  a  Sterilizer  of  In- 
struments, etc 476 

T  TLCERATION 30 

^      Ulceration,  Alveolar 47 

Ulcers  of  Mouth,  Syphilitic  ...     51 

Ulitis 50 

Unerupted  Impacted  Tooth...     54 
Unguentum  Acidi  Carbolici...  176 

Acidi  Tannici 203 

Boricum 173 

Creasoti 324 

Galte 185 

Hydrargy ri 36 1 

Verat rina 483 

Ureth ran 480 

Urethrane 480 

WALERIAN 480 

*    Valerianate  of  Ammonium 

241,  481 

Varnish,  Colored 462 

Aqueous 462 

Transparent 461 

Dental 369 

Vaselin 481 

Vaseline 481 

Vaseline  Camphor  Ice 482 

Veratrina  483 

Veratrine 483 

Veratrum  Viride 484 

Vermifuges 1 40 

Vermilion,  Effects  of,  on  Mouth  362 

Vesicants 137,  151 

Vinum  Opii 421 

Pepsini 425 

Virginia  Snake  Root 461 

Vitalized  Air 226 

Voltaic  Narcotism 226 

W ALB'S  Method  of  Using 
Cocaine 312 

Obolinskie's  Method 314 

Raymond's    Method 313 

Weights  and  Measures 76 

White  Oak   Bark ..  45' 

Wliitc  Oxide  of  Arsenic 157 

Witch  Hazel 353 


524 


GENERAL   INDEX. 


PAGE 

Wild  Cherry 449 

Windle's  Methx)d  of   Admin- 
istering Ansethestics 219 

Wine  of  Opium 421 

Wood  Charcoal 280 

VANTHOXYLUM 485 


PAGE 

'\/"ELLOW  Cinchona 300 

^  Jasmine 348 

Yversen's  Method  of  Admin- 
istering Anaesthetics 219 

yiNCl  Chloridum 486 

^         lodidum 489 

Oxidum 490 

Sulphas 491 


CATALOGUE 
No.  1. 


SEPTEMBER.  1891. 

CATALOGUE 


MEDICAL,  DENTAL, 

PHARMACEUTICAL  AND  SCIENTIFIC  PUBLICATIONS, 
WITH  A  SUBJECT  INDEX, 

PUBLISHED  BY 

P.  BLAKISTON,  SON  &  CO., 

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In  Medicine.         -  7.50 

Carpenter.     The  Microscope. 

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2  vols.     350  Illustrations.  

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lormulary.      -        -  2.25 

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Black.     Formation  of. 

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Tanner.     Memoranda  of. 
PRACTICE. 

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Fagge's  Practice.     2  Vols. 

Fowler's  Dictionary  of. 

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,  "  I Jind  it  an  excellent  work,  doing  credit  to  the  learning  and  discrimination  of  the  author." 


A  New  Medical  Dictionary, 


Small   8vo,  Half  Morocco,  as  above,  with 

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A  compact,  concise  Vocabulary,  including 
all  the  Words  and  Phrases  used  in  medicine, 
with  their  proper  Pronunciation  and  Defini- 
tions. 

BASED  ON  RECENT  MEDICAL 
LITERATURE. 

BY 

GEORGE  M.  GOULD,  A.B.,  M.D., 

Ophthahnic  Surgeon  to  the  Philadelphia  Hospital,  Clinical 
Chief  Ophthahnological  Dept.   German  Hos- 
pital, Philadelphia. 

It  is  not  a  mere  compilation  from  other 
dictionaries.  The  definitions  have  been 
made  by  the  aid  of  the  most  recent  stan- 
dard text-books  in  the  various  branches  of 
medicine.     It  includes 


SEVERAL  THOUSAND  NEW  WORDS  NOT  CONTAINED  IN 
ANY   SIMILAR  WORK. 

IT  CONTAINS  TABLES  of  the  ABBREVIATIONS  used  in  Medicine,  of  the 
ARTERIES,  of  the  BACILLI,  giving  the  Name,  Habitat,  Characteristics,  etc.;  of  GAN- 
GLIA, LEUCOMAINES,  MICROCOCCI,  MUSCLES,  NERVES,  PLEXUSES, 
PTOMAINES,  with  the  Name,  Formula,  Physiological  Action,  etc.;  and  the  COMPARI- 
SON OF  THERMOMETERS,  ofall  the  most  used  WEIGHTS  AND  MEASURES 
of  the  world,  of  the  MINERAL  SPRINGS  OF  THE  U.  S.,  VITAL  STATISTICS, 
etc.     Much  of  the  material  thus  classified  is  not  obtainable  by  English  readers  in  any  other  work. 

OPINIONS  OF  PROMINENT  MEDICAL  PAPERS. 

"  One  pleasing  feature  of  the  book  is  that  the  reader  can  almost  invariably 
find  the  definition  under  the  word  he  looks  for,  without  being  referred  from 
one  place  to  another,  as  is  too  commonly  the  case  in  medical  dictionaries. 
The  tables  of  the  bacilli,  micrococci,  leucomaines  and  ptomaines  are  excellent, 
and  contain  a  large  amount  of  information  in  a  limited  space.  The  anatomical 
tables  are  also  concise  and  clear.  .  .  .  We  should  unhesitatingly  recom- 
mend this  dictionary  to  our  readers,  feeling  sure  that  it  will  prove  of  much 
value  to  them." — American  Journal  of  Medical  Science,  Sept.  i8go. 

^' As  a  handy,  concise  and  accurate,  and  complete  medical  dictionary  it 
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taking  handiness  and  cheapness  into  account,  we  certainly  think  this  is  the 
general  practitioner's  model  dictionary,  and  we  cordially  recommend  it  to  our 
readers.  The  definitions  are  for  the  most  part  terse  and  accurate,  and  the 
derivations  up  to  modern  lights." — British  Medical  Journal,  London,  Sept.  i8go. 
S&"  May  be  obtained  through  all  Booksellers.     Sample  pages  free. 


p.  BLAKISTON,  SON  &  CO.'S 
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AITKEN.  Animal  Alkaloids,  the  Ptomaines,  Leucomaines  and  Extractives  in 
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ALLEN,   HARLAN,   HARTE,  VAN   HARLINGEN.     Local   Therapeutics. 

A  Handbook  of  Local  Therapeutics,  being  a  practical  description  of  all  those 
agents  used  in  the  local  treatment  of  disease,  such  as  Ointments,  Plasters, 
Powders,  Lotions,  Inhalations,  Suppositories,  Bougies,  Tampons,  etc.,  and  the 
proper  methods  of  preparing  and  applying  them.  By  Harrison  Allen,  m.d., 
Emeritus  Professor  of  Physiology  in  the  University  of  Penna. ;  Laryngologist  to 
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Joseph's  Hospitals.  George  C.  Harlan,  m.d.,  late  Professor  of  Diseases  of  the 
Eye  in  the  Philadelphia  Polyclinic  and  College  for  Graduates  in  Medicine ; 
Surgeon  to  the  Wills  Eye  Hospital,  and  Eye  and  Ear  Department  of  the  Penn- 
sylvania Hospital.  Richard  H.  Hart5,  m.d..  Demonstrator  of  Osteology, 
University  of  Pennsylvania  ;  Assistant  Surgeon,  University  Hospital,  and  Arthur 
Van  Harlingen,  m.d..  Professor  of  Diseases  of  the  Skin  in  the  Philadelphia 
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pital. In  One  Handsome  Compact  Volume.     Nearly  Ready. 

ALLEN.    Commercial  Organic  Analysis.    A  Treatise  on  the  Modes  of  Assaying 
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Medicine,  etc.,  with  Concise  Methods  for  the  Detection  of  Impurities,  Adultera- 
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Vol.  I.  Alcohols,  Ethers,  Vegetable  Acids,  Starch,  etc.  Out  of  Print. 

Vol.  II.  Fixed  Oils  and   Fats,  Hydrocarbons  and  Mineral  Oils,  Phenols  and 
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McCall  Anderson,  m.d..  Professor  of  Clinical  Medicine,  University  of  Glasgow. 
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Second  Edition.     32mo.  Boards,  $1.25 

5 


p.  BLAKISTON,  SON  &-  CO:S 


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BEALE.  On  Slight  Ailments ;  their  Nature  and  Treatment.  By  Lionel  S.  Beale, 
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Students  and  Physicians.  By  Prof.  John  B.  Biddle,  m.d.,  Professor  of  Materia 
Medica  in  Jefferson  Medical  College,  Philadelphia.  The  Eleventh  Edition,  thor- 
oughly revised,  and  in  many  parts  rewritten,  by  his  son,  Clement  Biddle,  m.d., 
Assistant  Surgeon,  U.  S.  Navy,  and  Henry  Morris,  m.d.,  Fellow  of  the  College 
of  Physicians,  of  Philadelphia,  etc.  Cloth,  ^4.25;  Sheep,  ^5.00 

BIGELOW.  Plain  Talks  on  Medical  Electricity  and  Batteries,  with  a  Thera- 
peutic Index  and  a  Glossary.  Prepared  for  Practitioners  and  Students  of  Medi- 
cine. By  Horatio  R.  Bigelow,  m.d..  Fellow  of  the  British  Gynaecological 
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MEDICAL  AND  SCIENTIFIC  PUBLICA  TIONS.  7 

BLACK.  Micro-Organisms.  The  Formation  of  Poisons.  A  Biological  study  of 
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BLODGETT'S  Dental  Patholog-y.  By  Albert  N.  Blodgett,  m.d.,  Late  Prof  of 
Pathology  and  Therapeutics,  Boston  Dental  Coll.    33  Illus.     i2mo.    Cloth,  $1.75 

BLOXAM.  Chemistry,  Inorganic  and  Organic.  With  Experiments.  By 
Charles  L.  Bloxam.  Edited  by  J.  M.  Thompson,  Professor  of  Chemistry  in 
King's  College,  London,  and  A.  G.  Bloxam,  Dem,  of  Chem.,  Royal  Agricultural 
College,  Cirencester.  Seventh  Edition.  Revised  and  Enlarged.  "With  281 
Engravings.     8vo.  Cloth,  $4.50;  Leather,  $5.50 

BOWIBY.    Injuries  and  Diseases  of  the  Nerves,  and  their  surgical  treatment. 
By  Anthony  A.  Bowlby,  f.r.c.s.,  Dem.  of  Practical  Surgery  at  St.  Bartholo- 
mew's Hospital.    Illus.  by  4  Colored  and  20  full-page  plates.    Svo.      Cloth,  ^4.50 
Surgical  Pathology  and  Morbid  Anatomy.     135  Illustrations.  Cloth,  $2.00 

BOWMAN.  Practical  Chemistry,  including  analysis,  with  about  100  Illustrations. 
By  Prof  John  E.  Bowman.  Eighth  English  Edition.  Revised  by  Prof.  Bloxam, 
Professor  of  Chemistry,  King's  College,  London.  Cloth,  $2.00 

BRITBAKER.  Physiology.  A  Compend  of  Physiology,  specially  adapted  for  the 
use  of  Students  and  Physicians.  By  A.  P.  Brubaker,  m.d..  Demonstrator  of 
Physiology  at  Jefferson  Medical  College,  Prof,  of  Physiology,  Penn'a  College  of 
Dental  Surgery,  Philadelphia.  Sixth  Edition.  Revised,  Enlarged  and  Illus- 
trated.   No.  4,? Quiz- Compend  Series?    i2mo.    Cloth,  $i.cx);  Interleaved,  $1.25 

BTJCKNILL  AND  TUKE'S  Manual  of  Psychological  Medicine :  containing 
the  Lunacy  Laws,  the  Nosology,  ^Etiology,  Statistics,  Description,  Diagnosis, 
Pathology  (including  morbid  Histology)  and  Treatment  of  Insanity.  By  John 
Charles  Bucknill,  m.d.,  f.r.s.,  and  Daniel  Hack  Tuke,  m.d.,  f.r.c.f. 
Fourth  Edition.    Numerous  illustrations.     Svo.  Cloth,  $8.00 

BTTLKLEY.  The  Skin  in  Health  and  Disease.  By  L.  Duncan  Bulkley,  m.d.. 
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BUXTON.  On  Anaesthetics.  A  Manual.  By  Dudley  Wilmot  Buxton,  m.r.c.s., 
M.R.C.P.,  Asst.  to  Prof,  of  Med.,  and  Administrator  of  Anaesthetics,  University 
College  Hospital,  London.     Practical  Series.     {See page  ig^  Cloth,  $1.25 

BURNET.  Foods  and  Dietaries.  A  Manual  of  Clinical  Dietetics.  By  R.  W. 
Burnet,  m.d.,  m.r.c.p..  Physician  to  the  Great  Northern  Central  Hospital. 
General  Contents — Diet  in  Derangementa  of  the  Digestive,  Nervous  and  Res- 
piratory Organs ;  in  Gout,  Rheumatism,  Anaemia,  Fevers,  Obesity,  etc. ;  in  Dis- 
eases of  Children,  Alcoholism,  etc.  With  Appendix  on  Predigested  Foods  and 
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BURNETT.  Hearing,  and  How  to  Keep  It.  By  Chas.  H.  Burnett,  m.d.,  Prof, 
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BYFORD.  Diseases  of  Women.  The  Practice  of  Medicine  and  Surgery,  as 
applied  to  the  Diseases  and  Accidents  Incident  to  Women.  By  W.  H.  Byford, 
a.m.,  m.d..  Professor  of  Gynaecology  in  Rush  Medical  College  and  of  Obstetrics 
in  the  Woman's  Medical  College;  Surgeon  to  the  Woman's  Hospital ;  Ex-Presi- 
dent American  Gynaecological  Society,  etc.,  and  Henry  T.  Byford,  m.d.,  Sur- 
geon to  the  Woman's  Hospital  of  Chicago ;  Gynaecologist  to  St.  Luke's  Hos- 
pital ;  President  Chicago  Gynaecological  Society,  etc.  Fourth  Edition.  Revised, 
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Octavo.     832  pages.  Cloth,  $5.00;  Leather,  $6.00 

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CAIRD  and  CATHCART.  Surgical  Handbook  for  the  use  of  Practitioners  and 
Students.  By  F.  Mitchell  Caird,  m.){.,  f.k.c.s.,  and  C.  Walker  Cathcart, 
M.B.,  f.r.c.s.,  Asst.  Surgeons  Royal  Infirmary.  With  over  200  Illustrations. 
32mo.     400  pages.     Pocket  size.  Leather  covers,  ;?2. 50 


8  P.  BLAKISTON,  SON  <S-  CO:S 

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Soap  and  Candles.  A  New  Handbook  for  Manufacturers,  Chemists,  Ana- 
lysts, etc.  Compiled  from  all  reliable  and  recent  sources.  54  Illustrations. 
i2mo.  Cloth,  $2.25 

CARPENTER.  Tlie  Microscope  and  Its  Revelations.  By  W.  B.  Carpenter, 
M.D.,  F.R.s.  Seventh  Edition.  Revised  and  Enlarged,  with  over  500  Illustra- 
tions and  Lithographs.  New  Edition  Nearly  Ready. 

CAZEAUX  and  TARNIER'S  Midwifery.  With  Appendix,  by  Munde.  Eighth 
Revised  and  Enlarged  Edition.  With  Colored  Plates  and  numerous  other 
Illustrations.  The  Theory  and  Practice  of  Obstetrics  ;  including  the  Diseases 
of  Pregnancy  and  Parturition,  Obstetrical  Operations,  etc.  By  P.  Cazeaux, 
Member  of  the  Imperial  Academy  of  Medicine,  Adjunct  Professor  in  the  Faculty 
of  Medicine  in  Paris.  Remodeled  and  rearranged,  with  revisions  and  additions, 
by  S.  Tarnier,  m.d..  Professor  of  Obstetrics  and  Diseases  of  Women  and 
Children  in  the  Faculty  of  Medicine  of  Paris.  Eighth  American,  from  the 
Eighth  French  and  First  Italian  Edition.  Edited  and  Enlarged  by  Robert 
J.  Hess,  m.d..  Physician  to  the  Northern  Dispensary,  Phila.,  etc.,  with  an  Ap- 
pendix by  Paul  F.  Munde,  m.d.,  Professor  of  Gynaecology  at  the  New  York 
Polyclinic,  and  at  Dartmouth  College ;  Vice-President  American  Gynaecological 
Society,  etc.  Illustrated  by  Chromo-Lithographs,  Lithographs,  and  other  Full- 
page  Plates,  seven  of  which  are  beautifully  colored,  and  numerous  Wood  En- 
gravings.    Students'  Edition.    One  Vol.,  8vo.     Cloth,  $5.00;  Full  Leather,  $6.00 

CLEVELAND'S  Pocket  Dictionary.  A  Pronouncing  Medical  Lexicon,  containing 
correct  Pronunciation  and  Definition  of  terms  used  in  medicine  and  the  col- 
lateral sciences,  abbreviations  used  in  prescriptions,  list  of  poisons,  their  anti- 
dotes, etc.  By  C.  H.  Cleveland,  m.d.  Thirty-third  Edition.  Very  small 
pocket  size.  Cloth,  .75;  Tucks  with  Pocket,  $1.00 

COHEN.  The  Throat  and  Voice.  ByJ.  Solis-Cohen,  m.d.  Illus.  i2mo.    Cloth,  .50 

COLLIE,  On  Fevers.  A  Practical  Treatise  on  Fevers,  Their  History,  Etiology, 
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Lond.     With  Colored  Plates.    Practical  Series.     See  Page  ig.  Cloth,  ^2.50 

CROCKER.  Diseases  of  the  Skin.  Their  Description,  Pathology,  Diagnosis  and 
Treatment.  By  H.  Radcliffe  Crocker,  m.d.,  Physician  to  the  Dept.  of  Skin 
Dis.  University  College  Hospital,  London.     With  Illustrations.  Cloth,  $5.50 

CTJLLINGWORTH.   A  Manual  of  Nursing,  Medical  and  Surgical.    By  Charles 

J.  Cullingworth,    m.d..    Physician  to  St.  Thomas'  Hospital,  London.     Third 

Revised  Edition.     With  18  Illustrations.     i2mo.  Cloth,  .75 

A  Manual  for  Monthly  Nurses.    Third  Edition.    32mo.  Cloth,  .50 

DAVIS.  Biology.  An  Elementary  Treatise.  By  J.  R.  Ainsworth  Davis,  of 
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DAVIS.     A  Manual  of  Obstetrics.     Being  a  complete  manual  for  Physicians  and 

Students.     By  Edward  P.  Davis,  m.d.,  Demonsti-ator  of  Obstetrics,  Jefferson 

Medical   College ;    Physician   to   the  Philadelphia  Hospital ;    Editor  American 

Journal  Medical  Sciences  ;  etc.     With  Colored  Lithograph  Plates  and  150  other 

Illustrations.     i2mo.  Nearly  Ready. 

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DAY.     On  Headaches.     The  Nature,  Causes  and  Treatment  of  Headaches.     By 

Wm.  H.  Day,  m.d.     Fourth  Edition.    Illustrated.    Svo.    Paper,  .75;  Cloth,  $1.25 

DERMATOLOGY,  Journal  of.    Edited  by  Malcolm  Morris,  m.r.c.s.  London, 

and  D.  G.  Brooke,  m.r.c.s.  Manchester,  Eng.     Monthly.       Per  Annum,  I3.00 

DOMVILLE.  Manual  for  Nurses  and  others  engaged  in  attending  to  the  sick.  By 
Ed.  J.  Domville,  m.d.  7th  Edition,  Revised.  With  Recipes  for  Sick-room 
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DORAN.  Gynaecological  Operations.  A  Handbook.  By  Alban  Doran,  f.r.c.s., 
Asst.  Surg,  to  the  Samaritan  Free  Hospital  for  Women  and  Children,  London.' 
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DUCKWORTH.  On  Gout.  Illustrated.  A  treatise  on  Gout.  Bv  Sir  Dyce 
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Medicine  at,  St.  Bartholomew's  Hospital,  London.  With  Chromo-lithographs 
and  Engravings.     Octavo.  Cloth,  $7.00 

DULLES.  What  to  Do  First,  In  Accidents  and  Poisoning.  By  C.  W.  Dulles,  m.d. 
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EDIS.  Sterility  in  Women.  By  A.  W.  Edis,  m.d.,  f.r.c.p.,  late  President  British 
Gynaecological  Society;  Senior  Physician,  Chelsea  Hospital  for  Women;  Physician 
to  British  Lying-in  Hospital,  etc.     Illustrated.     8vo.  Cloth,  $1.75 

FAGGE.  The  Principles  and  Practice  of  Medicine.  By  C.  Hilton  Fagge,  m.d., 
F.R.C.P.,  F.R.M.C.S.,  Examiner  in  Medicine,  University  of  London  ;  Physician  to, 
and  Lecturer  on  Pathology  in,  Guy's  Hospital ;  Senior  Physician  to  Evelina  Hos- 
pital for  Sick  Children,  etc.  Arranged  for  the  press  by  Philip  H.  Pye-Smith, 
M.D.,  Lect.  on  Medicine  in  Guy's  Hospital.  Including  a  section  on  Cutaneous 
Affections,  by  the  Editor;  Chapter  on  Cardiac  Diseases,  by  Samuel  Wilkes,  m.d., 
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FENWICK.  Student's  Guide  to  Physical  Diagnosis.  By  Saml.  Fenwick,  m.d., 
M.R.C.P.,  Physician  to  the  London  Hospital.  Seventh  Edition.  117  Illustrations. 
i2mo.  Cloth,  $2.25 

FIELD.  Evacuant  Medication — Cathartics  and  Emetics.  By  Henry  M.  Field, 
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ber Gynaecological  Society  of  Boston,  etc.     i2mo.     288  pp.  Cloth,  51.75 

FILLEBROWN.  A  Text-Book  of  Operative  Dentistry.  Written  by  invitation 
of  the  National  Association  of  Dental  Faculties.  By  Thomas  Fillebrown,  m.d., 
D.M.D.,  Professor  of  Operative  Dentistry  in  the  Dental  School  of  Harvard  Uni- 
versity;  Member  of  the  American  Dental  Assoc,  etc.    Illus.    8vo.      Clo.,  $2.50 

FLAGG.  Plastics  and  Plastic  Fillings,  as  pertaining  to  the  filling  of  all  Cavities 
of  Decay  in  Teeth  below  medium  in  structure,  and  to  difficult  and  inaccessible 
cavities  in  teeth  of  all  grades  of  structure.  By  J.  Foster  Flagg,  d.d.s..  Professor 
of  Dental  Pathology  in  Philadelphia  Dental  College.  Fourth  Revised  Edition. 
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FLOWER'S  Diagrams  of  the  Nerves  of  the  Human  Body.  Exhibiting  their 
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of  the  Cutaneous  Surface  and  to  all  the  Muscles.  By  William  H.  Flower, 
F.R.C.S.,  F.R.S.,  Hunterian  Professor  of  Comparative  Anatomy,  and  Conservator 
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revised.     With  six  Large  Folio  Maps  or  Diagrams.     4to.  Cloth,  ;i53.50' 

FLUCKIGER.  The  Cinchona  Barks  Pharmacognostically  Considered.  By 
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Power,  PH.D.     With  8  Lithographic  Plates.     Royal  octavo.  Cloth,  $1.50 

FOWLER'S  Dictionary  of  Practical  Medicine.  By  Various  Writers.  An  Ency- 
clopedia of  Medicine.  Edited  by  James  Kingston  Fowler,  m.a.,  m.d.,  f.r.c.p., 
Senior  Asst.  Physician  to,  and  Lecturer  on  Pathological  Anatomy  at,  the  Mid- 
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FOX   AND   GOULD.     Compend  on  Diseases  of  the  Eye  and  Refraction, 

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Assistant,  Ophthalmological  Department,  Jefferson  Medical  College  Hospital ; 
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at  Moorfields,  London,  England,  etc.,  and  Geo.  M.  Gould,  m.d.  Second  Edition. 
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Woman's  Medical  College;  Physician  in  charge  of,  and  Obstetrician  and 
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GOODHART  and  STARR'S  Diseases  of  Children.  The  Student's  Guide  to  the 
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Second  American  from  the  Third  English  Edition.  Rearranged  and 
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the  University  of  Maryland.     Fourth  Edition.     Revised  and  Enlarged.     8vo. 

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GOULD'S  New  Medical  Dictionary.  Including  all  the  Words  and  Phrases  used 
in  Medicine,  with  their  proper  Pronunciation  and  Definitions,  based  on  Recent 
Medical  Literature.  By  George  M.  Gould,  b.a.,  m.d..  Ophthalmic  Surgeon  to 
the  Philadelphia  Hospital,  etc..  With  Tables  of  the  Bacilli,  Micrococci,  Leuco- 
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GOWERS,  Manual  of  Diseases  of  the  Nervous  System.  A  Complete  Text-book. 
By  William  R.  Gowers,  m.d.,  Prof.  Clinical  Medicine,  University  College. 
London.  Physician  to  National  Hospital  for  the  Paralyzed  and  Epileptic.  Second 
Edition.  Revised,  Enlarged  and  in  many  parts  rewritten.  With  many  new 
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Diag^nosis  of  Diseases  of  the  Brain.    8vo.    Second  Ed.    Illus.    Cloth,  J2.00 
Diagnosis  of  Diseases  of  the  Spinal  Cord.    4th  Edition.  Preparing. 

Medical  Ophthalmoscopy.  A  Manual  and  Atlas,  with  Colored  Autotype  and 
Lithographic  Plates  and  Wood-cuts,  comprising  Original  Illustrations  of  the 
changes  of  the  Eye  in  Diseases  of  the  Brain,  Kidney,  etc.  Third  Edition. 
Revised,  with  the  assistance  of  R.  Marcus  Gunn,  f.r.c.s..  Surgeon,  Royal 
London  Ophthalmic  Hospital,  Moorfields.     Octavo.  Cloth,  $5! 50 

Syphilis  and  the  Nervous  System.  Being  the  Lettsomian  Lectures  for  1889. 
8vo.  j,i  Press. 

GROSS'S  Biog-raphy  of  John  Hunter.  John  Hunter  and  His  Pupils.  By  Profes- 
sor S.  D.  Gross,  m.d.     With  a  Portrait.     Svo.  Paper,  .75 

GREENHOW.  Chronic  Bronchitis,  especially  as  connected  with  Gout,  Emphysema, 
and  Diseases  of  the  Heart.     By  E.  Headlam  Greenhow,  m.d.     i2mo. 

Paper,  .75  ;  Cloth,  $1.25 

GRIFFITH'S  Graphic  Clinical  Chart.  Designed  by  J.  P.  Crozer  Griffith, 
M.D.,  Instructor  in  Clinical  Medicine  in  the  University  of  Pennsylvania.  Printed 
in  three  colors.     Sample  copies  free.  Put  up  in  loose  packages  of  50,    .50 

Price  to  Hospitals,  500  copies,  J4.00;  1000  copies,  %"] .^o.  With  name  of  Hos- 
pital printed  on,  50  cents  extra. 

GROVES  AND  THORP.  Chemical  Technology.  A  new  and  Complete  Work. 
The  Application  of  Chemistry  to  the  Arts  and  Manufactures.  Edited  by 
Charles  E.  Groves,  f.r.s.,  and  Wm.  Thorp,  b.sc,  f.i.c.  In  about  eight  vol- 
umes, with  numerous  illustrations.     Each  voltane  sold  separately. 

Vol.  I.  Fuel.  By  Dr.  E.  J.  Mills,  f.r.s.,  Professor  of  Chemistry,  Anderson 
College,  Glasgow;  and  Mr.  F.  J.  Rowan,  assisted  by  an  American  expert.  607 
Illustrations  and  4  plates.     Octavo.  Cloth,  7.50;  Half  Morocco,  $9.00 

HADDON'S  Embryology.  An  Introduction  to  the  Study  of  Embryology.  For 
the  Use  of  Students.  By  A.  C.  Haddon,  m.a.,  Prof,  of  Zoology,  Royal  College 
of  Science,  Dublin.     190  Illustrations.  Cloth,  j;6.oo 

HALE.  On  the  Management  of  Children  in  Health  and  Disease.  A  Book  for 
Mothers.     By  Amie  M.  Hale,  m.d.    New  Enlarged  Edition.     i2mo.     Cloth,  .75 

HARE.  Mediastinal  Disease.  The  Pathology,  Clinical  History  and  Diagnosis  of 
Affections  of  the  Mediastinum  other  than  those  of  the  Heart  and  Aorta,  with 
tables  giving  the  Clinical  History  of  520  cases.  The  essay  to  which  was  awarded 
the  FothergiUian  Medal  of  the  Medical  Society  of  London,  1888.  By  H.  A. 
Hare,  m.d.  (Univ.  of  Pa.),  Professor  of  Materia  Medica  and  Therapeutics  in 
Jefferson  Medical  College,  Philadelphia.     Svo.     Illustrated  by  Six  Plates. 

Cloth,  %2.oo 

HARLAN.  Eyesight,  and  How  to  Care  for  It.  By  George  C.  Harlan,  m.d., 
Prof,  of  Diseases  of  the  Eye,  Philadelphia  Polyclinic.     Illustrated.        Cloth,  .50 

HARRIS.  On  the  Chest.  Including  the  Principal  Affections  of  the  Plcuric,  Lungs, 
Pericardium,  Heart  and  Aorta.  By  Vincent  D.  Harris,  f.r.c.i*..  Physician  to 
the  Victoria  Park  Hospital  for  Diseases  of  the  Chest,  London.  With  55  Illus- 
trations. Cloth,  #2.50 


12  P.  BLAKISTON,  SON  6^  CO:S 

HAKRIS'S  Principles  and  Practice  of  Dentistry.  Including  Anatomy,  Physi- 
ology, Pathology,  Therapeutics,  Dental  Surgery  and  Mechanism.  By  Chapin  A, 
Harris,  m.d.,  d.d.s.,  late  President  of  the  Baltimore  Dental  College,  author  of 
"Dictionary  of  Medical  Terminology  and  Dental  Surgery."  Twelfth  Edition. 
Revised  and  Edited  by  Ferdinand  J,  S.  Gorgas,  a.m.,  m.d.,  d.d.s.,  author  of 
"  Dental  Medicine ;"  Professor  of  the  Principles  of  Dental  Science,  Dental 
Surgery  and  DentaJ  Mechanism  in  the  University  of  Maryland.  Two  Full-page 
Plates  and  1086  Illustrations.    1225  pages.    8vo.        Cloth,  $7.00 ;  Leather,  ^8.00 

Dictionary  of  Dentistry.  Fifth  Edition,  Revised.  Including  Definitions  of 
such  Words  and  Phrases  of  the  Collateral  Sciences  as  Pertain  to  the  Art  and 
Practice  of  Dentistry.  Fifth  Edition.  Rewritten,  Revised  and  Enlarged. 
By  Ferdinand  J.  S.  Gorgas,  m.d.,  d.d.s.,  Author  of  "Dental  Medicine;" 
Editor  of  Harris's  "Principles  and  Practice  of  Dentistry;"  Professor  of 
Principles  of  Dental  Science,  Dental  Surgery,  and  Prosthetic  Dentistry  in  the 
University  bf  Maryland.     Octavo.  Cloth,  #5.00  ;  Leather,  $6.00 

HARTRIDGE.  Refraction.  The  Refraction  of  the  Eye.  A  Manual  for  Students. 
By  GuSTAVUS  Hartridge,  f.r.c.s..  Consulting  Ophthalmic  Surgeon  to  St.  Bar- 
tholomew's Hospital ;  Ass't  Surgeon  to  the  Royal  Westminster  Ophthalmic  Hos- 
pital, etc.     96  Illustrations  and  Test  Types.     Fifth  Edition.  Cloth,  ^1.75 

On  The  Ophthalmoscope.  A  Manual  for  Physicians  and  Students.  With 
Colored  Plates  and  many  Woodcuts.     i2mo.  Nearly  Ready. 

HARTSHORNE.  Our  Homes.  Their  Situation,  Construction,  Drainage,  etc.  By 
Henry  Hartshorne,  m.d.     Illustrated.  Cloth,  .50 

HATFIELD.  Diseases  of  Children.  By  Marcus  P.  Hatfield,  Professor  of 
Diseases  of  Children,  Chicago  Medical  College.  With  a  Colored  Plate.  Being 
N0.14,?  Quiz- Compend?  Series.     i2mo.  Cloth,  $1.00 

Interleaved  for  the  addition  of  notes,  ^1.25 

HEADLAND'S  Action  of  Medicines.  On  the  Action  of  Medicines  in  the  System. 
By  F.  W.  Headland,  m.d.     Ninth  American  Edition.     8vo.  Cloth,  $3.00 

HEATH'S  Minor  Surgery  and  Bandaging.  By  Christopher  Heath,  f.r.c.s., 
Holme  Professor  of  Clinical  Surgery  in  University  College,  London.  Ninth 
Edition.     Revised  and  Enlarged.     With  142  Illustrations.     i2mo.      Cloth,  ^2.00 

Practical  Anatomy.  A  Manual  of  Dissections.  Seventh  London  Edition. 
24  Colored  Plates,  and  nearly  300  other  Illustrations.  Cloth,  $5.00 

Injuries  and  Diseases  of  the  Jaws.  Third  Edition.  Revised,  with  over 
150  Illustrations.     8vo.  Cloth,  1^4.50 

Lectures  on  Certain  Diseases  of  the  Jaws,  delivered  at  the  Royal  College  of 
Surgeons  of  England,  1887.     64  Illustrations.     8vo.  Boards,  ;^i. 00 

HENRY.  Anaemia.  A  Practical  Treatise.  By  Fred'k  P.  Henry,  m.d..  Prof. 
Clinical  Med.  Phila.  Polyclinic,  Physician  to  Episcopal  and  Phila.  Hospitals,  to 
Home  for  Consumptives,  etc.     i2mo.  Half  Cloth,  .75 

HIGGENS'  Ophthalmic  Practice.  A  Manual  for  Students  and  Practitioners.  By 
Charles  Higgens,  f.r.c.s.  Ophthalmic  Surgeon  at  Guy's  Hospital.  Practical 
Series.     See  Page  ig.  Cloth,  $1.75 

HILL  AND  COOPER.  Venereal  Diseases.  The  Student's  Manual  of  Venereal 
Diseases,  being  a  concise  description  of  those  Affections  and  their  Treatment. 
By  Berkeley  Hill,  m.d.,  Professor  of  Clinical  Surgery,  University  College,  and 
Arthur  Cooper,  m.d.,  Late  House  Surgeon  to  the  Lock  Hospital,  London. 
4th  Edition.     i2mo.  Cloth,  $1.00 


MEDICAL  AND  SCIENTIFIC  PUBLICA  TIONS.  13 


HOLDEN'S  Anatomy.  A  Manual  of  the  Dissections  of  the  Human  Body.  By 
Luther  Holden,  f.r.c.s.  Fifth  Edition.  Carefully  Revised  and  Enlarged. 
Specially  concerning  the  Anatomy  of  the  Nervous  System,  Organs  of  Special 
Sense,  etc.  By  John  Langton,  f.r.c.s..  Surgeon  to,  and  Lecturer  on  Anatomy 
at,  St.  Bartholomew's  Hospital.     208  Illustrations.     8vo. 

Oilcloth  Covers,  for  the  Dissecting  Room,  $4.50 
Human  Osteology.  Comprising  a  Description  of  the  Bones,  with  Colored 
Delineations  of  the  Attachments  of  the  Muscles.  The  General  and  Micro- 
scopical Structure  of  Bone  and  its  Development.  Carefully  Revised.  By 
the  Author  and  Prof.  Stewart,  of  the  Royal  College  of  Surgeons'  Museum. 
With  Lithographic  Plates  and  Numerous  Illustrations.  7th  Ed.  Cloth,  $6.00 
Landmarks.     Medical  and  Surgical.     4th  Edition.     Svo.  Cloth,  $1.25 

HOLLAND.  The  TTrine,  the  Common  Poisons  and  the  Milk.  Memoranda,  Chem- 
ical and  Microscopical,  for  Laboratory  Use.  By  J.  W.  Holland,  m.d.,  Professor 
of  Medical  Chemistry  and  Toxicology  in  Jefferson  Medical  College,  of  Philadel- 
phia. Fourth  Edition.  Revised  and  Enlarged.  Illustrated  and  Interleaved. 
i2mo.  Cloth,  $1.00 

HORWITZ'S  Compend  of  Surgery,  including  Minor  Surgery,  Amputations,  Frac- 
tures, Dislocations,  Surgical  Diseases,  and  the  Latest  Antiseptic  Rules,  etc.,  with 
Differential  Diagnosis  and  Treatment.  By  Orville  Horwitz,  b.s.,  m.d..  Dem- 
onstrator of  Anatomy,  Jefferson  Medical  College ;  Chief,  Out-Patient  Surgical 
Department,  Jefferson  Medical  College  Hospital.  Third  Edition.  Very  much 
Enlarged  and  Rearranged,  gi  Illustrations  and  77  Formulae.  i2mo.  No.g  ?Quiz- 
Compend?  Series.  Cloth,  $1.00.     Interleaved  for  the  addition  of  notes,  $1.25 

HTJFELAND.  Long  Life.  Art  of  Prolonging  Life.  By  C.  W.  Hufeland. 
Edited  by  Erasmus  Wilson,  M.D.     i2mo.  Cloth,  51.00 

HUGHES.  Compend  of  the  Practice  of  Medicine.  Fourth  Edition.  Revised  and 
Enlarged.  By  Daniel  E.  Hughes,  m.d.,  Demonstrator  of  Clinical  Medicine  at 
Jefferson  Medical  College,  Philadelphia.  In  two  parts.  Being  Nos.  2  a)id  j, 
f  Quiz-  Cempend  ?  Series. 

Part  I. — Continued,  Eruptive  and  Periodical  Fevers,  Diseases  of  the  Stomach, 
Intestines,  Peritoneum,  Biliary  Passages,  Liver,  Kidneys,  etc.,  and  General 
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Part  II. — Diseases  of  the  Respiratory  System,  Circulatory  System  and  Ner- 
vous System  ;  Diseases  of  the  Blood,  etc. 

Price  of  each  Part,  in  Cloth,  $1.00;  interleaved  for  the  addition  of  Notes,  $1.25 
Physicians'  Edition. — In  one  volume,  including  the  above  two  parts,  a  sec- 
tion on  Skin  Diseases,  and  an  index.     Fourth  revised,  etilarged  Edition. 
462  pages.  Full  Morocco,  Gilt  Edge,  ii?2.5o 

HUMPHREY.  A  Manual  for  Nurses.  Including  general  Anatomy  and  Physiology, 
management  of  the  sick  room,  etc.  By  Laurence  Humphrey,  m.a.,  m.b., 
M.K.C.S.,  Assistant  Physician  to,  and  Lecturer  at,  Addenbrook's  Hospital,  Cam- 
bridge, England.     4th  Edition.     i2mo.     Illustrated.  Cloth,  $1.25 

HUTCHINSON.  The  Nose  and  Throat.  A  Manual  of  the  Diseases  of  the  Nose 
and  Throat,  including  the  Nose,  Naso-Pharynx,  Pharynx  and  Larynx.  By 
Procter  S.  Hutchinson,  m.r.c.s.,  Asst.  Surgeon  to  the  London  Hospital  for 
Diseases  of  the  Throat.  Illustrated  by  several  Lithograph  Plates  and  40  other 
plates,  many  of  which  have  been  made  from  original  drawings.   i2mo.  Clolh,J!i.25 

JACOBSON.  Operations  of  Surgery.  By  W.  H.  A.  Jacobson.  b.a.  oxon., 
F.R.C.S.,  Eng. ;  Ass't  Surgeon,  Guy's  Hospital;  Surgeon  at  Royal  Hospital  for 
Children  and  Women,  etc.     With  over  200  lUust.      Cloth,  ;g5.oo ;  Leather,  $6.00 

JAWORSKI.  Carlsbad  Sprudel  Salt.  Its  Action,  Therapeutic  Value  and  Use, 
and  Its  relation  to  the  Carlsbad  Thermal  Water.  By  Dr.  W.  Javvokski,  Univer- 
sitats-Dozenten  in  Krakau,  with  a  Dietary  by  the  Translator,  A.  L.  A.  Touolut, 
M.D.,  Asst.  Demonstrator  of  Pharmacy,  University  of  Pennsylvania. 

Octavo.     Cloth,  $2.00 


14  P.  BLAKISTON,  SON  &^  CO:S 

KIRKES' Physiology.  [Authorized  Editioft,  127110.  Dark  Red  Cloth.)  A  Hand- 
book of  Physiology.  Twelfth  London  Edition,  Revised  and  Enlarged.  By  W. 
MoRRANT  Baker,  m.d.,  and  Vincent  Dormer  Harris,  m.d.  502  Illustrations. 
i2mo.     880  Pages.  Cloth,  I4.00;  Leather,  $5.00 

LANDIS'  Compend  of  Obstetrics  ;  especially  adapted  to  the  Use  of  Students  and 
Physicians.  By  Henry  G.  Landis,  m.d.,  Professor  of  Obstetrics  and  Diseases 
of  Women,  in  St,arling  Medical  College,  Columbus,  Ohio.  Fourth  Edition. 
Enlarged.     With  Many  Illustrations,     No.  §? Quiz- Compend?  Series. 

Cloth,  $1.00;  interleaved  for  the  addition  of  Notes,  $1.25 

LANDOIS.  A  Text-Book  of  Human  Physiology  ;  including  Histology  and  Micro- 
scopical Anatomy,  with  special  reference  to  the  requirements  of  Practical  Medi- 
cine. By  Dr.  L.  Landois,  Professor  of  Physiology  and  Director  of  the  Physio- 
logical Institute  in  the  University  of  Greifswald.  Third  American,  translated 
from  the  Sixth  German  Edition,  with  additions,  by  Wm.  Stirling,  m.d.,  d.sc., 
Brackenbury  Professor  of  Physiology  and  Histology  in  Owen's  College,  Man- 
chester ;  Examiner  in  Physiology  in  University  of  Oxford,  England.  With  692 
Illustrations.     Svo.  Cloth,  $6.50;  Leather,  $7.50 

LEBER  AND  ROTTENSTEIN.  Dental  Caries  and  Its  Causes.  An  Investigation 
into  the  Influence  of  Fungi  in  the  Destruction  of  the  Teeth.  By  Drs.  Leber 
and  Rottenstein.     Illustrated.  Paper,  .75 

LEE.  The  Microtomist's  Vade  Mecum.  Second  Edition.  A  Handbook  of 
Methods  of  Microscopical  Anatomy.  By  Arthur  Bolles  Lee,  Asst.  in  the  Rus- 
sian Laboratory  of  Zoology,  at  Villefranche-sur-Mer  (Nice).  660  Formulae,  etc. 
Enlarged  and  Revised.  Cloth,  ^4.00 

LEFFMANN'S  Compend  of  Chemistry,  Inorganic  and  Organic.  Including  Urine 
Analysis.  By  Henry  Leffmann,  m.d..  Prof,  of  Chemistry  and  Metallurgy  in 
the  Penna.  College  of  Dental  Surgery,  and  in  the  Wagner  Free  Institute  of 
Science,  Philadelphia.  No.  10  ? Quiz- Compend  ?  Series.  Third  Edition.  Re- 
written and  Adapted  for  Students  of  Medicine  and  Dentistry.     i2mo. 

Cloth,  ^i.oo.     Interleaved  for  the  addition  of  Notes,  $1.25 

LEFFMANN  &  BEAM.  Examination  of  Water  for  Sanitary  and  Technical  Pur- 
poses. By  Henry  Leffmann,  m.d..  Professor  of  Chemistry  and  Metallurgy, 
Penna.  College  of  Dental  Surgery,  Hygienist  and  Food  Inspector  Penna.  State 
Board  of  Agriculture,  etc.;  and  William  Beam,  a.m.,  formerly  Chief  Chemist 
B.  &  O.  R.  R.  Second  Edition.  Enlarged.  Illustrated.  i2mo.  Cloth,  $1.25 
Progressive  Exercises  in  Practical  Chemistry.  A  Laboratory  Handbook. 
Illustrated.     i2mo.  Cloth,  $1.00 

LEGGr  on  the  Urine.  Practical  Guide  to  the  Examination  of  the  Urine,  for 
Practitioner  and  Student.  By  J.  Wickham  Legg,  m.d.  Sixth  Edition,  Enlarged. 
Illustrated.     i2mo.  Cloth,  .75 

LEWERS.  On  the  Diseases  of  Women.  Second  Edition.  With  146  Engravings. 
Practical  Series.     See  Page  ig.     i2mo.  Cloth,  $2.50 

LEWIS,  (BEVAN).  Mental  Diseases.  A  text-book  having  special  reference  to  the 
Pathological  aspects  of  Insanity.  By  Bevan  Lewis,  l.r.c.p.,  m.r.c.s.,  Medi- 
cal Director,  West  Riding  Asylum,  Wakefield,  England,  18  Lithographic  plates 
and  other  Illustrations.     Svo.  Cloth,  $6.00 

LIEBREICH'S  Atlas  of  Ophthalmoscopy,  composed  of  12  Chromo-Lithographic 

'  Plates  (containing  59  Figures),  with  Text.     Translated  by  H.  R.  Swanzy,  m.d. 

Third  Edition.     4to.  Boards,  ^15.00 

LINCOLN.    School  and  Industrial  Hygiene.    By  D.  F.  Lincoln,  m.d.    Cloth,  .50 

LIZARS,  (JOHN).    On  Tobacco.    The  Use  and  Abuse  of  Tobacco.         Cloth,  .50 

LONGLEY'S  Pocket  Medical  Dictionary  for  Students  and  Physicians.  Giving 
the  Correct  Definition  and  Pronunciation  of  all  Words  and  Terms  in  General 
Use  in  Medicine  and  the  Collateral  Sciences,  with  an  Appendix,  containing 
Poisons  and  their  Antidotes,  Abbreviations  Used  in  Prescriptions,  and  a  Metric 
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MEDICAL  AND  SCIENTIFIC  PUBLICA  TIONS.  15 


LtfCKES.  Hospital  Sisters  and  their  Duties.  By  Eva  C.  E.  Luckes,  Matron  to 
the  London  Hospital;  Author  of"  Lectures  on  Nursing."     i2mo.       Cloth,  $1.00 

MAC  MTJNN.  Chemistry  of  Urine.  Illustrated.  Outlines  of  the  Clinical 
Chemistry  of  Urine.  By  C.  A.  Mac  Munn,  m.a.,  xM.d.,  Dublin.  Sixty-four  Wood- 
cuts and  Plate  of  Spectra.     Octavo.  '^^.oo 

MACNAMARA.  On  the  Eye.  A  Manual  of  the  Diseases  of  the  Eye.  By  C. 
Macxamara,  m.d.  Fifth  Edition,  Carefully  Revised;  with  Additions  and 
Numerous  Colored  Plates,  Diagrams  of  Eye,  Wood-cuts,  and  Test  Types. 
Demi  8vo.  Cloth,  §4.00 

MACALISTER'S  Human  Anatomy.  800  Illustrations.  A  New  Text-book  for 
Students  and  Practitioners.  Systematic  and  Topographical,  includino-  the 
Embryology,  Histology  and  Morphology  of  Man.  With  special  reference  to  the 
requirements  of  Practical  Surgery  and  Medicine.  By  Alex.  Macalister,  m.d., 
F.R.S.,  Professor  of  Anatomy  in  the  University  of  Cambridge,  England;  Examiner 
in  Zoology  and  Comparative  Anatomy,  University  of  London ;  formerly  Professor 
of  Anatomy  and  Surgery,  University  of  Dublin.  With  816  Illustrations,  400  of 
which  are  original.     Octavo.  Cloth,  $7.50;  Leather,  $8.50 

MACDONALD'S  Microscopical  Examinations  of  Water  and  Air.  A  Guide  to  the 
Microscopical  Examination  of  Drinking  Water,  with  an  Appendix  on  the  Micro- 
scopical Examination  of  Air.  By  J.  D.  Macdonald,  m.d.  With  25  Litho- 
graphic Plates,  Reference  Tables,  etc.    Second  Ed.,  Revised.     8vo.   Cloth,  J52.75 

MACKENZIE.    The  (Esophagus,  Nose,  Naso-Pharynx,  etc.    By  Sir  Morell 

Mackenzie,  m.d.,  Senior  Physician  to  the  Hospital  for  Diseases  of  the  Chest 

and  Throat,  London.     lUus.     Being  Vol.  II  of  the  First  Edition  of  his  Treatise 

on  the  Throat  and  Nose.     Complete  in  itself.  Cloth,  ^3.00;  Leather,  $4.00 

The  Pharmacopoeia  of  the  Hospital  for  Diseases  of  the  Throat  and  Nose. 

Fourth  Edition,  Enlarged,  Containing  250  Formulae,  with  Directions  for  their 

Preparation  and  Use.     i6mo.  Cloth,  $1.25 

MANN'S  Manual  of  Psychological  Medicine  and  Allied  Nervous  Diseases.  Their 
Diagnosis,  Pathology,  Prognosis  and  Treatment,  including  their  Medico-Legal 
Aspects  ;  with  chapter  on  Expert  Testimony,  and  an  abstract  of  the  laws  relating 
to  the  Insane  in  all  the  States  of  the  Union.  By  Edward  C.  Mann,  m.d., 
member  of  the  New  York  County  Medical  Society.  With  Illustrations  of  Typical 
Faces  of  the  Insane,  Handwriting  of  the  Insane,  and  Micro-photographic  Sec- 
tions of  the  Brain  and  Spinal  Cord.     Octavo.  Cloth,  $5.00;  Leather  $6.00 

MARSHALL'S  Physiological  Diagrams,  Life  Size,  Colored.  Eleven  Life-size 
Diagrams  (each  7  feet  by  3  feet  7  inches).  Designed  for  Demonstration  before 
the  Class.  By  John  Marshall,  f.r.s.,  f.r.c.s.,  Professor  of  Anatomy  to  the 
Royal  Academy ;  Professor  of  Surgery,  University  College,  London,  etc. 

In  Sheets  Unmounted,  net,  ^40.00 
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No.  4 — The  Heart  and  Principal  Blood-vessels.  No.  5 — The  Lymphatics  or  Absorb- 
ents. No.  6 — The  Digestive  Organs.  No.  7 — The  Brain  and  Nerves.  Nos.  8  and  9 — 
The  Organs  of  the  Senses.  Nos.  10  and  11 — The  Microscopic  Structure  of  the 
Textures  and  Organs.     (Send for  Special  Circular.') 

MARSHALL  &  SMITH.  On  the  Urine.  The  Chemical  Analysis  of  the  Urine. 
By  John  Marshall,  m.d.,  and  Prof.  Edgar  F.  Smith,  of  the  Chemical  Labora- 
tories, University  of  Pennsylvania.  Phototype  Plates.  i2mo.  Cloth,  $1.00 
MASON'S  Compend  of  Electricity,  and  its  Medical  and  Surgical  Uses.  By 
Charles  V.  Mason,  m.d..  Assistant  Surgeon  U.  S.  Army.  With  an  Intro- 
duction by  Charles  H.  May,  m.d.,  Instructor  in  the  New  York  Polyclinic. 
Numerous  Illustrations.     i2mo.                                                                  Cloth,  $i. 00 


16  P.  BLAKISTON,  SON  &>  CO:S 

MAXWELL.  Terminologia  Medica  Polyglotta.  By  Dr.  Theodore  Maxwell, 
assisted  by  others  in  various  countries.     8vo.  Cloth,  ^4.00 

The  object  of  this  work  is  to  assist  the  medical  men  of  any  nationality  in  reading  medical  literature  written 
in  a  language  not  their  own.  Each  term  is  usually  given  in  seven  languages,  viz. :  English,  French,  German, 
Italian,  Spanish,  Russian  and  Latin. 

MAYS'  Therapeutic  Forces  ;  or,  The  Action  of  Medicine  in  the  Light  of  the  Doc- 
trine of  Conservation  of  Force.  By  Thomas  J.  Mays,  m.d.  Cloth,  $1.25 
Theine  in  the  Treatment  of  JNeuralgia.  Being  a  Contribution  to  the  Thera- 
peutics of  Pain.     i6mo.                                                                      yi  bound,  .50 

MEDICAL  Directory  of  Philadelphia  and  Camden,  1889.  Containing  hsts  of 
Physicians  of  all  Schools  of  Practice,  Dentists,  Veterinarians,  Druggists  and 
Chemists,  with  information  concerning  Medical  Societies,  Colleges  and  Associa- 
tions, Hospitals,  Asylums,  Charities,  etc.  Morocco,  Gilt  edges,  $2.50 

MEIG-S.  Milk  Analysis  and  Infant  Feeding.  A  Practical  Treatise  on  the  Ex- 
amination of  Human  and  Cows'  Milk,  Cream,  Condensed  Milk,  etc.,  and 
Directions  as  to  the  Diet  of  Young  Infants.  By  Arthur  V.  Meigs,  m.d..  Physi- 
cian to  the  Pennsylvania  Hospital,  Philadelphia.     i2mo.  Cloth,  $1.00 

MEIGS  and  PEPPER  on  Children.  A  Practical  Treatise  on  the  Diseases  of 
Children.  By  J.  Forsyth  Meigs,  m.d.,  Fellow  of  the  College  of  Physicians  of 
Philadelphia,  etc.,  etc.,  and  William  Pepper,  m.d.,  Professor  of  the  Principles 
and  Practice  of  Medicine  in  the  Medical  Department,  University  of  Pennsyl- 
vania.    Seventh  Edition.  Cloth,  $5.00;  Leather,  $6.00 

MERRELL'S  Digest  of  Materia  Medica.  Forming  a  Complete  Pharmacopoeia  for 
the  use  of  Physicians,  Pharmacists  and  Students.  By  Albert  Merrell,  m.d. 
Octavo.  Half  dark  Calf,  $4.00 

MEYER.  Ophthalmology.  A  Manual  of  Diseases  of  the  Eye.  By  Dr.  Edouard 
Meyer,  Prof,  a  L'Ecole  de  la  Faculte  de  Medicine  de  Paris,  Chev.  of  the  Legion 
of  Honor,  etc.  Translated  from  the  Third  French  Edition,  with  the  assistance 
of  the  author,  by  A.  Freedland  Fergus,  m.b..  Assistant  Surgeon  Glasgow 
Eye  Infirmary.  With  270  Illustrations,  and  two  Colored  Plates  prepared 
under  the  direction  of  Dr.  Richard  Liebreich,  m.r.c-s.,  Author  of  the  "Atlas 
of  Ophthalmoscopy."     8vo.  Cloth,  $4.50  ;  Leather,  $5.50 

MILLER  and  LIZAR'S  Alcohol  and  Tobacco.  Alcohol.  Its  Place  and  Power. 
By  James  Miller,  f.r.c.s.  ;  and.  Tobacco,  Its  Use  and  Abuse.  By  John  Lizars, 
M.D.     The  two  essays  in  one  volume.  Cloth,  ^i.oo;  Separate,  each  .50 

MILLS.  Fuel  and  Its  Applications.  By  E.  J.  Mills,  d.sc,  f.r.s.,  and  E.  J. 
Rowan,  c.e.  (See  Groves  and  Thorp  Technology.)  8vo.  Clo.,$7.5o;  Half  Mor.  $9.00 

MONEY.  On  Children.  Treatment  of  Disease  in  Children,  including  the  Outlines 
of  Diagnosis  and  the  Chief  Pathological  Differences  between  Children  and 
Adults.  By  Angel  Money,  m.d.,  m.r.c.p.,  Asst.  Physician  to  the  Hospital  for 
Sick  Children,  Great  Ormond  St.,  and  to  the  Victoria  Park  Chest  Hospital,  Lon- 
don.    Practical  Series.     See  Page  ig.     i2mo.     560  pages.  Cloth,  $3.00 

MORRIS.  Compend  of  Gynaecology.  By  Henry  Morris,  m.d..  Demonstrator  of 
Obstetrics,  Jefferson  Medical  College,  Phila.,  etc.  With  Forty-five  illustrations. 
Being  ?  Quiz- Compend  f  No.  7.  Cloth,  ^i.oo  ;  Interleaved  for  Notes,  $1.25 

MOITLLIN.  Surgery.  A  Complete  Text-book.  By  C.  W.  Mansell  Moullin, 
M.A.,  M.D.  OXON.,  F.R.C.S.,  Surgeon  and  Lecturer  on  Physiology  to  the  London 
Hospital ;  formerly  Radclifife  Travelling  Fellow  and  Fellow  of  Pembroke  Col- 
lege, Oxford.  497  Illustrations,  200  of  which  are  original.  Royal  Octavo.  1190 
pages.  Cloth,  $7.00;  Leather,  $8. 00 

Subscription  Edition.  With  Colored  Lithograph  Plate  and  with  many 
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MTJRRELL.  Massotherapeutics.  Massage  as  a  Mode  of  Treatment,  By  Wm. 
MuRRELL,  M.D.,  F.R.C.P.,  Lecturer  on  Pharmacology  and  Therapeutics  at  West- 
minster HospitaL  5th  Edition.  Revised.  i2mo.  Cloth,  $1.50 
Chronic  Bronchitis  and  its  Treatment.  {Authorized  Edition)  A  Clinical 
Study.     i2mo.     176  pages.  Cloth,  $1.50 


MEDICAL  AND  SCIENTIFIC  PUBLICA  TIONS.  17 


MORTON  on  Refraction  of  the  Eye.  Its  Diagnosis  and  the  Correction  of  its  Errors. 
With  Chapter  on  Keratoscopy,  and  Test  Types.  By  A.  Morton,  m.b.  Third 
Edition,  Revised  and  Enlarged.  Cloth,  $1.00 

MTJTER.  Practical  and  Analytical  Chemistry.  By  John  Muter,  f.r.s.,  f.c.s., 
etc.  Fourth  Edition.  Revised,  to  meet  the  requirements  of  American  Medical 
Colleges,  by  Claude  C.  Hamilton,  m.d.,  Professor  of  Analytical  Chemistry 
in  University  Med.  Col.,  and  Kansas  City  Col.  of  Pharmacy.    51  Illus.    Cloth,  $2.00 

liTAPHEYS'  Modern  Therapeutics.  New  Revised  Edition,  Enlarg^ed  and  Im- 
proved. In  Two  Handsome  Volumes.  Edited  by  Allen  J.  Smith,  m.d.,  Asst. 
Demonstrator  of  Morbid  Anatomy  and  Pathological  Histology,  Lecturer  on 
Urinology,  University  of  Pennsylvania  ;  Physician  in  the  Dispensary  for  Diseases 
of  Children,  University  Hospital,  etc. ;  and  J.  Aubrey  Davis,  m.d.,  Assistant 
Demonstrator  of  Obstetrics,  University  of  Pennsylvania.  Nca7-ly  Ready. 

Vol.  I.— Medical  Therapeutics.  Therapeutics  of  Diseases  of  Children. 
Vol.  II.— Surgical  Therapeutics.  Therapeutics  of  Gynaecology  and 
Obstetrics. 

NEW  SYDENHAM  SOCIETY  Publications.  Three  to  Six  Volumes  published 
each  year.     List  of  Vohunes  upon  application.  Per  annum,  $8.00 

OBERSTEINER,  The  Anatomy  of  the  Central  Nervous  Organs.  A  Guide  to  the 
study  of  their  structure  in  Health  and  Disease.  By  Professor  H.  Obersteiner, 
of  the  University  of  Vienna.  Translated,  with  annotations  and  additions,  by 
Alex.  Hill,  M.A.,  M.D.,  Master  of  Downing  College,  Cambridge.  198  Illustrations. 
Sq.  Octavo.  Cloth,  $6.00 

OPHTHALMIC  REVIEW.  A  Monthly  Record  of  Ophthalmic  Science.  Published 
in  London.     Sample  Numbers,  2^  cents.  Per  annum,  $3.00 

OSGOOD.    The  Winter  and  Its  Dangers.    By  Hamilton  Osgood,  m.d.  Cloth,  .50 

OSLER.  Cerebral  Palsies  of  Children.  A  Clinical  Study  from  the  Infirmary  for 
Nervous  Diseases,  Philadelphia.  By  William  Osler,  m.d.,  f.r.c.p.,  London, 
etc.     8vo.  Cloth,  |2.oo 

OSTROM.  Massage  and  the  Original  Swedish  Movements.  Their  Application 
to  Various  Diseases  of  the  Body.  A  Manual  for  Students,  Nurses  and  Physicians. 
By  Kurre  W.  Ostrom,  from  the  Royal  University  of  Upsala,  Sweden ;  Instructor 
in  Massage  and  Swedish  Movements  in  the  Hospital  of  the  University  ot 
Pennsylvania,  and  in  the  Philadelphia  Polyclinic  and  College  for  Graduates  in 
Medicine,  etc.  Second  Edition.  Enlarged.  Illustrated  by  70  Wood  Engrav- 
ings, many  of  which  were  drawn  especially  for  this  purpose.    l2mo.     Cloth,  $1  00 

OVERMAN'S  Practical  Mineralogy,  Assaying  and  Mining,  with  a  Description  of 
the  Useful  Minerals,  etc.  By  Frederick  Overman,  Mining  Engineer.  Elev- 
enth Edition.     i2mo.  Cloth,  $1.00 

PACKARD'S  Sea  Air  and  Sea  Bathing.  By  John  H.  Packard,  one  of  the  Phy- 
sicians to  the  Pennsylvania  Hospital,  Philadelphia.  Cloth,  .50 

PAGE.  Railroad  Injuries.  With  Special  Reference  to  those  of  the  Back  and 
Nervous  System.  By  Herbert  Page,  m.a.,  m.c,  cantab.,  f.r.c.s.,  Eng.  Sur- 
geon to  St.  Mary's  Hospital,  and  Lecturer  on  Surgery  at  its  Medical  School. 
Square  Octavo.  Cloth,  #2.25 

Injuries  of  the  Spine  and  Spinal  Cord,  without  apparent  Lesion  and  Nervous 
Shock.  In  their  Surgical  and  Medico-Legal  Aspects.  Third  Edition, 
Revised.     Octavo.  Lh-eparino. 

PARKES'  Practical  Hygiene.  By  Edward  A.  Parkes,  m.d.  The  Eighth  Re- 
vised and  Enlarged  Edition.  Edited  by  J.  Lane  Notter,  m.a.,  m.d.,  f.c.s., 
Professor  of  Hygiene,  Army  Medical  School,  Netley,  England.  With  10  Litho- 
graphic Plates,  and  over  100  other  Illustrations.     8vo.  Cloth,  $5.00 

PARKES.  Hygiene  and  Public  Health.  A  Practical  Manyal.  By  Louis  C. 
Parkes,  m.d.,  d.p.h.  London  Hospital;  Assistant  Professor  of  Hygiene  -ind 
Pubhc  Health,  at  University  College,  etc.     i2mo.     Second  Edition.     Cloth,  )i52. 50 

PARRISH'S  Alcoholic  Inebriety.  From  a  Medical  Standpoint,  with  Illustrative 
Cases  from  the  Clinical  Records  of  the  Author.  By  Joseph  Pakkish,  m.d.. 
President  of  the  Amer.  Assoc,  for  Cure  of  Inebriates.      Paper,  .75  ;  Cloth,  #1.25 


18  P.  BLAKISTON,  SON  &-•  CO:S  PUBLICA  TIONS. 

PARVIN'S  Winckel's  Diseases  of  Women.    (See  Winckel,  page  25.) 

PARVIN.    Lectures  on  Obstetric  Nursing.    Delivered  at  the  Training  School  for 

Nurses  of  the  Philadelphia  Hospital.     By  Theophilus  Parvin,  m.d.,  Professor 

of  Obstetrics  and  Diseases  of  Women  and  Children,  at  Jefferson  Medical  College ; 

Obstetrician  to  Philadelphia  Hospital.     i2mo.  Cloth,  .75 

PENNSYLVANIA  Hospital  Reports.  Edited  by  a  Committee  of  the  Hospital 
Staff:  J.  M.  DaCosta,  m.d.,  and  William  Hunt.  Containing  Original  Articles 
by  the  Staff.     With  many  other  Illustrations.  Paper,  .75  ;  Cloth,  $1.25 

PHYSICIAN'S  VISITING  LIST.  Published  Annually.  Fortieth  Year  of  its 
Publication. 

REGULAR  EDITION. 
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5°  iwo\.%.     I  July  to  Dec.  j  •        •  ^-5° 

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^°°  ^^°^^-      1  July  to  Dec]  •        '  3-oo 

INTERLEAVED  EDITION". 

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50        "            "                "                "           "        "         "  ««  .        .          1.50 

.<             .<  -      1       f  Jan.  to  Tune  ]      ,,        .,         „  .,  „  ^^ 

50                      "2  vols.    {}ulytoDec.|                        "  "  .        .          3-00 

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S@"  This  List  combines  the  several  essential  qualities  of  strength,  compactness, 
durability  and  convenience.  It  is  made  in  all  sizes  and  styles  to  meet  the  wants  of  all 
physicians.  It  is  not  an  elaborate,  complicated  system  of  keeping  accounts,  but  a 
plain,  simple  record,  that  may  be  kept  with  the  least  expenditure  of  time  and  trouble — 
hence  its  popularity.  A  special  circular,  descriptive  of  contents  and  improvements, 
will  be  sent  upon  application. 

PEREIRA'S  Prescription  Sook.  Containing  Lists  of  Terms,  Phrases,  Contrac- 
tions and  Abbreviations  used  in  Prescriptions,  Explanatory  Notes,  Grammatical 
Construction  of  Prescriptions,  Rules  for  the  Pronunciation  of  Pharmaceutical 
Terms.  By  Jonathan  Pereira,  m.d.  Sixteenth  Edition.  Cloth,  $1.00;  Tucks  ^1.25 

PIGGOTT  Copper  Mining  and  Copper  Ore.     i2mo.  Cloth,  |i. 00 

PORTER'S  Surgeon's  Pocket-Book.  By  Surgeon-Major  J.  H.  Porter,  late  Pro- 
fessor of  Military  Surgery  in  the  Army  Medical  School,  Netley,  England.  Revised, 
and  partly  Rewritten.     Third  Edition.     Small  i2mo.  Leather  Covers,  ^2.25 

POWER,  HOLMES,  ANSTIE  and  BARNES  (Drs.).  Reports  on  the  Progress  of 
Medicine,  Surgery,  Physiology,  Midwifery,  Diseases  of  Women  and  Children, 
Materia  Medica,  Medical  Jurisprudence,  Ophthalmology,  etc.  Reported  for  the 
New  Sydenham  Society.     8vo.  Paper,  .75  ;  Cloth,  $1.25 

POTTER.  A  Handbook  of  Materia  Medica,  Pharmacy  and  Therapeutics,  in- 
cluding the  Action  of  Medicines,  Special  Therapeutics,  Pharmacology,  etc.  In- 
cluding over  600  Prescriptions  and  Formulae.  By  Samuel  O.  L.  Potter,  m.a., 
M.D.,  M.R.c.P.  (Lond.),  Professor  of  the  Practice  of  Medicine,  Cooper  Medical  Col- 
lege, San  Francisco ;  late  A.  A.  Surgeon  U.  S.  Army.  Third  Edition,  Revised  and 
Enlarged.    8vo.     With  Thumb  Index  in  each  copy.     Cloth,  $4.00;  Leather,  ^5.00 


THE   PRACTICAL  SERIES. 


THREE  NEW  VOLUMES. 


PARKES.  Hygiene  and  Public  Health.  A  Practical  Manual.  By  Louis  C. 
Parkes,  M.D.,  D.P.H.,  London  Hospital;  Fellow  of  the  Sanitary  Institute; 
Assistant  Professor  of  Hygiene  and  Public  Health,  at  University  College,  etc. 
i2mo.     Second  Edition.  Cloth,  $2.50 

LEWERS.  On  the  Diseases  of  Women.  A  Practical  Treatise.  By  Dr.  A.  H. 
N.  Lewers,  Assistant  Obstetric  Physician  to  the  London  Hospital;  and  Phy- 
sician to  Out-patients,  Queen  Charlotte's  Lying-in  Hospital ;  Examiner  in  Mid- 
wifery and  Diseases  of  Women  to  the  Society  of  Apothecaries  of  London.  With 
146  Engravings.     Second  Edition,  Revised.  Cloth,  ;g2.5o 

BTJXTON.  On  Anaesthetics.  A  Manual  of  their  Uses  and  Administration.  By 
Dudley  Wilmot  Buxton,  m.d.,  b.s.,  Ass't  to  Prof,  of  Med.,  and  Administrator 
of  Anaesthetics,  University  College  Hospital,  London.     Illustrated. 

Second  Edition  in  Press. 


MONET.  On  Children.  Treatment  of 
Disease  in  Children,  including  the  Out- 
lines of  Diagnosis  and  the  Chief 
Pathological  Differences  between  Chil- 
dren and  Adults.  By  Angel  Money, 
M.D.,  M.R.C.P.,  Ass't  Physician  to  the 
Hospital  for  Sick  Children,  Great 
Ormond  St.,  and  to  the  Victoria  Park 
Chest  Hospital,  London.  i2mo.  560 
pages.  Cloth,  $3.00 

PRITCHARD.  On  the  Ear.  Handbook 
of  Diseases  of  the  Ear.  By  Urban 
Pritchard,  M.D.,  F.R.C.S.,  Professor 
of  Aural  Surgery,  King's  College, 
London,  Aural  Surgeon  to  King's 
College  Hospital,  Senior  Surgeon  to 
the  Royal  Ear  Hospital,  etc.  i2mo. 
2d  Edition.    Illustrated.    Cloth,  $1.50 

BARRETT.  Dental  Surgery  for  Gen- 
eral Practitioners  and  Students  of 
Medicine  and  Dentistry.  Extraction 
of  Teeth,  etc.  By  A.  W.  Barrett, 
M.D.  2d  Edition,  Revised  and  En- 
larged.   80  Illustrations.    Cloth,  $1.25 


COLLIE  On  Fevers.  A  Practical  Treat- 
ise on  Fevers,  Their  History,  Etiology. 
Diagnosis,  Prognosis  and  Treatment. 
By  Alexander  Collie,  m.d.,  m.r.- 
C.P.,  Lond.  Medical  Officer  of  the  Ho- 
merton,  and  of  the  London  Fever  Hos- 
pitals.    Colored  Plates.       Cloth,  $2.50 

RALFE.    Diseases  of  the  Kidney  and 

Urinary  Derangements.  By  C.  H. 
Ralfe,  M.D.,  F.R.C.P.,  Ass't  Physician 
to  the  London  Hospital.  Illustrated. 
i2mo.  Cloth,  $2.75 

REEVES.     Bodily    Deformities    and 

their    Treatment.      A   Handbook  of 
Practical    Orthopaedics.      By    H.    A. 
Reeves,  m.d.,  Senior  Ass't  Surgeon  to 
the  London  Hospital,  Surgeon  to  the 
Royal  Orthopaedic  Hospital.  228  Illus. 
Cloth,  $2.25 
HIGGENS.    Ophthalmic  Practice.    A 
Manual  for  Students  and  Practitioners. 
By  Charles  Higgins,  f.r.c.p.,  Opllial- 
mic  Surgeon  to  Guy's  Hospital.     Illus- 
trated.    274  pages.  Cloth,  $1.75 


%*  The  volumes  of  this  series,  written  by  well-known  physicians  and  surgeons  of  large 
private  and  hospital  experience,  emtarace  the  various  branches  of  medicine  and  surgery.  '1  hey 
are  of  a  thoroughly  practical  character,  calculated  to  meet  the  rc'iuirements  of  the  practitioner, 
and  present  the  most  recent  methods  and  information  in  a  compact  shape  and  at  a  low  price. 

Bound  Uniformly,  in  a  Handsome  and  Distinctive  Cloth  Binding,  and 
mailed  to  any  address,  on  receipt  of  the  price. 


20  P.  BLAKISTON,  SON  <S-  CO:S 

POTTER.  Compend  of  Anatomy,  including  Visceral  Anatomy.  Formerly  pub- 
lished separately.  Based  upon  Gray.  Fifth  Edition.  Revised,  and  greatly 
Enlarged.  With  i6  Lithographed  Plates  and  117  other  Illustrations.  Being  No. 
I  ?  Quiz- Co7np end?  Series.         Cloth,  $1.00;  Interleaved  for  taking  Notes,  I1.25 

Compend  of  Materia  Medica,  Therapeutics  and  Prescription  Writing, 

arranged  in  accordance  with  the  last  Revision  U.  S.  Pharmacopoeia,  with 
special  reference  to  the  Physiological  Action  of  Drugs.  Fifth  Revised  and 
Improved  Edition,  with  Index.     Being  No.  6  ?  Quiz-Compend?  Series. 

Cloth,  $1.00.     Interleaved  for  taking  Notes,  $1.25 

Speech    and    Its   Defects.     Considered  Physiologically,  Pathologically  and 

Remedially;  being  the  Lea  Prize  Thesis  of  Jefferson  Medical  College,  1882. 

Revised  and  Corrected.     i2mo.  Cloth,  $1.00 

PRITCHARD  on  the  Ear.  Handbook  of  Diseases  of  the  Ear.  By  Urban 
Pritchard,  M.D.,  F.R.C.S., Professor  of  Aural  Surgery,  King's  College,  London, 
Aural  Surgeon  to  King's  College  Hospital,  Senior  Surgeon  to  the  Royal  Ear 
Hospital,  etc.  Second  Edition.  Many  Illustrations  and  Formulae.  i2mo.  Prac- 
tical Series.     See  Page  iQ.  Cloth,  1 1.50 

PROCTER'S  Practical  Pharmacy.  Lectures  on  Practical  Pharmacy.  With  43 
Engravings  and  32  Lithographic  Fac -simile  Prescriptions.  By  Barnard  S. 
Procter.     Second  Edition.  Cloth,  $4.50 

RALFE.  Diseases  of  the  Kidney  and  Urinary  Derangements.  By  C.  H.  Ralfe. 
Illustrated.     i2mo.     Practical  Series.     See  Page  ig.  Cloth,  $2.75 

HAMSAY.  A  System  of  Inorganic  Chemistry.  By  William  Ramsay,  ph.d., 
F.R.S.,  Professor  of  Chemistry  in  University  College,  London.     Illustrated.     8vo. 

Cloth,  $4.50 

REESE'S  Medical  Jurisprudence  and  Toxicology.  A  Text-book  for  Medical  and 
Legal  Practitioners  and  Students.  By  John  J.  Reese,  m.d.,  Editor  of  Taylor's 
Jurisprudence,  Professor  of  the  Principles  and  Practice  of  Medical  Jurisprudence, 
including  Toxicology,  in  the  University  of  Pennsylvania  Medical  Department. 
Third  Edition.  Enlarged.  Crown  Octavo.  666  pages.    Cloth,  $3.00;  Leather,  ^3.50 

REEVES.  Bodily  Deformities  and  their  Treatment.  A  Handbook  of  Practical 
Orthopaedics.    By  H.  A.  Reeves,  m.d.    Practical  Series.    See  Page  ig.     CI. ,$2.25 

RICHARDSON.  Long  Life,  and  How  to  Reach  It,  By  J.  G.  Richardson,  Prof, 
of  Hygiene,  University  of  Penna.  Cloth,  .50 

RICHARDSON'S  Mechanical  Dentistry.  A  Practical  Treatise  on  Mechanical 
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With  569  Illustrations.     8vo.  Cloth,  $4.50  ;  Leather,  $5.50 

RIGBY'S  Obstetric  Memoranda.    4tb  Ed.    By  Meadows.    32mo.         Cloth,  .50 

RICHTER'S  Inorganic  Chemistry.  A  Text-book  for  Students.  By  Prof.  Victor 
VON  RiCHTER,  University  of  Breslau.  Third  American,  from  Fifth  German 
Edition.  Authorized  Translation  by  Edgar  F.  Smith,  m.a.,  ph.d..  Prof,  of 
Chemistry,  University  of  Pennsylvania,  Member  of  the  Chemical  Societies  of 
Berlin  and  Paris.    89  Illustrations  and  a  Colored  Plate.     i2mo.  Cloth,  $2.00 

Organic  Chemistry.    A  Text-book  for  Students.    Second  American  translated 
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ROBERTS.  Practice  of  Medicine.  The  Theory  and  Practice  of  Medicine.  By 
Frederick  Roberts,  m.d..  Professor  of  Therapeutics  at  University  College, 
London.    Eighth  Edition,  with  Illustrations.    8vo.      Cloth,  $5.50;  Leather,  $6.50 

ROBINSON.  Latin  Grammar  of  Pharmacy  and  Medicine.  By  D.  H.  Robinson, 
PH.D.,  Professor  of  Latin  Language  and  Literature,  University  of  Kansas,  Law- 
rence. With  an  Introduction  by  L.  E.  Sayre,  ph.g..  Professor  of  Pharmacy  in, 
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MEDICAL  AND  SCIENTIFIC  PUBLICA  TIONS.  21 

SANDERSON'S  Physiological  Laboratory.  A  Handbook  of  the  Physiological 
Laboratory.  Being  Practical  Exercises  for  Students  in  Physiology  and  Histofocry 
By  J.  BuRDOx  Sanderson,  m.d.,  E.  Klein,  m.d.,  Michael  Foster  m  d  f  r  s  " 
and  T.  Lauder  Brunton,  m.d.  With  over  350  Illustrations  and  Appropriate 
Letter-press  Explanations  and  References.     One  Volume.  Cloth,  $5.00 

SANSOM.  On  CMoroform.  Its  Action  and  Administration.  By  Arthur  Ernest 
Sansom,  M.D.     Illustrated.     i2mo.  Paper,  .75  ;  Cloth,  ;?  1.2 5 

SCHNEE.  Diabetes,  its  Cause  and  Permanent  Cure.  From  the  standpoint  of  ex- 
perience and  Scientific  Investigation.  By  Emil  Schnee,  Consulting  Physician 
at  Carlsbad.  Translated  from  the  German  by  R.  L.  Tafel,  a.m.,  ph.d.  Re- 
vised and  Enlarged  by  the  author.     Octavo.  Cloth,  $2.00 

SEWELL.  Dental  Surgery,  including  Special  Anatomy  and  Surgery.  By  Henry 
Sewell,  M.R.C.S.,  L.D.S.,  President  Odontological  Society  of  Great  Britain.  3d 
Edition,  greatly  enlarged,  with  about  200  Illustrations.  Cloth,  1:3.00 

SMITH'S  Wasting-  Diseases  of  Infants  and  Children.  By  Eustace  Smith,  m.d., 
F.R.C.P.,  Physician  to  the  East  London  Children's  Hospital.  Fifth  London 
Edition,  Enlarged.     8vo.  Cloth,  $3.00 

SMITH,  Abdominal  Surgery.  Being  a  Systematic  Description  of  all  the  Princi- 
pal Operations.  By  J.  Greig  Smith,  m.a.,  f.r.s.e.,  Surg,  to  British  Royal  In- 
firmary ;  Lecturer  on  Surgery,  Bristol  Medical  School ;  Late  Examiner  in  Surgery, 
University  of  Aberdeen,  etc'  Over  80  Illustrations.    Fourth  Edition.   Cloth,  jgj.oo 

SMITH.  Electro-Chemical  Analysis.  By  Edgar  F.  Smith,  Professor  of  Chem- 
istry, University  of  Penna.     26  Illustrations.     i2mo.  Cloth,  $1.00 

SMITH  AND  KELLER.  Experiments.  Arranged  for  Students  in  General  Chem- 
istry. By  Edgar  F.  Smith,  Professor  of  Chemistry,  University  of  Penn'a  and 
Dr.  H.  F.  Keller,  Professor  of  Chemistry,  Michigan  School  of  Mines,  Houghton, 
Michigan.     Second  Edition.     i2mo.     Illustrated.  Cloth,  net,  .60 

STAMMER.  Chemical  Problems,  with  Explanations  and  Answers.  By  Karl 
Stammer.  Translated  from  the  2d  German  Edition,  by  Prof.  W.  S.  Hoskinson, 
A.M.,  Wittenberg  College,  Springfield,  Ohio.     i2mo.  Cloth.  .75 

STARR.  The  Digestive  Organs  in  Childhood.  Second  Edition.  The  Diseases 
of  the  Digestive  Organs  in  Infancy  and  Childhood.  With  Chapters  on  the 
Investigation  of  Disease  and  the  Management  of  Children.  By  Louis  Starr, 
m.d.,  late  Clinical  Prof,  of  Diseases  of  Children  in  the  Hospital  of  the  University 
of  Penn'a;  Physician  to  the  Children's  Hospital,  Phila.  Second  Edition. 
Revised  and  Enlarged.  Illustrated  by  two  Colored  Lithograph  Plates  and 
numerous  wood-engravings.     Crown  Octavo.  Cloth,  $2.25 

The  Hygiene  of  the  Nursery,  including  the  General  Regimen  and  Feed- 
ing of  Infants  and  Children,  and  the  Domestic  Management  of  the  Ordinary 
Emergencies  of  Early  Life,  Massage,  etc.  Third  Edition.  Enlarged.  25 
Illustrations.     i2mo.     280  pages.  Cloth,  $1.00 

See  also  Goodhart  and  Starr.    Pa^e  10. 

STEWART'S  Compend  of  Pharmacy.  Based  upon  "  Remington's  Text-Book  of 
Pharmacy."  By  F.  E.  Stewart,  m.d.,  ph.g..  Quiz  Master  in  Chem.  and  Theoreti- 
cal Pharmacy,  Phila.  College  of  Pharmacy  ;  Demonstrator  and  Lect.  in  Piiarma- 
cology,  Medico-Chirurgical  College,  and  in  Woman's  Medical  College.  3d.  Ed. 
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and  an  elaborate  Index,     f  (Juiz- Compend  f  Series.  Cloth,  51.00 

Interleaved  for  the  addition  of  notes,  51.25 


22  P.  BLAKISTON,  SON  <S-  CO:S 

STIRLING.  Outlines  of  Practical  Physiology.  Including  Chemical  and  Experi- 
mental Physiology,  with  Special  Reference  to  Practical  Medicine.  By  W.  Stir- 
ling, M.D.,  Sc.D.,  Prof,  of  Phys.,  Owens  College,  Victoria  University,  Manchester. 
Examiner  in  Honors  School  of  Science,  Oxford,  England.  142  Illustrations. 
309  pages.  Cloth,  $2.25 

Outlines  of  Practical  Histology.     A  Manual  for  Students.     With  344  Illus- 
trations.    i2mo.  Cloth,  $4.00 

STOCKEN'S  Dental  Materia  Medica.  Dental  Materia  Medica  and  Therapeutics, 
with  Pharmacopoeia.     By  James  Stocken,  d.d.s.     Third  Edition.     Cloth,  $2.50 

STRAHAN.  Extra-Uterine  Pregnancy.  The  Diagnosis  and  Treatment  of  Extra- 
Uterine  Pregnancy.  Being  the  Jenks  Prize  Essay  of  the  College  of  Physicians 
of  Philadelphia.  By  John  Strahan,  m.d.  (Univ.  of  Ireland),  late  Res.  Surgeon 
Belfast  Union  Infirmary  and  Fever  Hospital.     Octavo.  Cloth,  $1.50 

SUTTON'S  Volumetric  Analysis.  A  Systematic  Handbook  for  the  Quantitative 
Estimation  of  Chemical  Substances  by  Measure,  Applied  to  Liquids,  Solids  and 
Gases.  By  Francis  Sutton,  f.c.s.  Sixth  Edition,  Revised  and  Enlarged, 
with  Illustrations.     8vo.  Cloth,  $5.00 

SUTTON.  Ligaments.  Their  Nature  and  Morphology.  By  John  Bland  Sutton, 
F.R.C.S.,  Lecturer  on  Pathology,  Royal  College  of  Surgeons ;  Assis.  Surg,  and 
Dem.  of  Anatomy,  Middlesex  Hospital,  London.    Illustrated.    i2mo.    Cloth,  $1.25 

SWAIN.  Surgical  Emergencies,  together  with  the  Emergencies  Attendant  on 
Parturition  and  the  Treatment  of  Poisoning.  A  Manual  for  the  Use  of  General 
Practitioners.     By  W.  F.  Swain,  f.r.c.S.     Fourth  Edition.     Illustrated.        $1.50 

SWANZY.  Diseases  of  tlie  Eye  and  their  Treatment.  A  Handbook  for  Physi- 
cians and  Students.  By  Henry  R.  Swanzy,  a.m.,  m.b.,  f.r.c.s.i..  Surgeon  to 
the  National  Eye  and  Ear  Infirmary  ;  Ophthalmic  Surgeon  to  the  Adelaide  Hos- 
pital, Dublin ;  Examiner  in  Ophthalmic  Surgery  in  the  Royal  University  of 
Ireland.  Third  Edition.  Thoroughly  Revised.  158  Illustrations.  508  pages. 
i2mo.  Cloth,  ^3.00 

SYMONDS.  Manual  of  Chemistry,  for  the  special  use  of  Medical  Students.  By 
Brandreth  Symonds,  a.m.,  M.D.,  Asst.  Physician  Roosevelt  Hospital,  Out- 
Patient  Department ;  Attending  Physician  Northwestern  Dispensary,  New  York. 
i2mo.  Cloth,  $2.00;  Interleaved  for  Notes,  ^2.40 

TAFT'S  Operative  Dentistry.     A  Practical  Treatise  on  Operative  Dentistry.     By 
Jonathan  Taft,  d.d.s.     Fourth  Revised  and  Enlarged  Edition.     Over  100  Il- 
lustrations.    8vo.  Cloth,  $4.25  ;  Leather,  $5.00 
Index  of  Dental  Periodical  Literature.    8vo.  Cloth,  $2.00 

TALBOT.  Irregularities  of  the  Teeth,  and  Their  Treatment.  By  Eugene  S. 
Talbot,  m.d..  Professor  of  Dental  Surgery  Woman's  Medical  College,  and 
Lecturer  on  Dental  Pathology  in  Rush  Medical  College,  Chicago.  Second  Edi- 
tion, Revised  and  Enlarged  by  about  100  pages.  Octavo.  234  Illustrations. 
(169  of  which  are  original).     261  pages.  Cloth,  $3.00 

TANNER'S  Memoranda  of  Poisons  and  their  Antidotes  and  Tests.  By  Thos. 
Hawkes  Tanner,  m.d.,  f.r.c.p.  Sixth  American,  from  the  Last  London  Edition. 
Revised  by  Henry  Leffmann,  m.d.,  Professor  of  Chemistry  in  Pennsylvania 
College  of  Dental  Surgery  and  in  the  Philadelphia  Polyclinic.    i2mo.     Cloth,  .75 

TAYLOR.  Practice  of  Medicine.  A  Manual.  By  Frederick  Taylor,  m.d., 
Physician  to,  and  Lecturer  on  Medicine  at  Guy's  Hospital,  London  ;  Physician  to 
Evelina  Hospital  for  Sick  Children,  and  Examiner  in  Materia  Medica  and  Phar- 
maceutical Chemistry,  University  of  London.  Cloth,  ^4.00 ;  Sheep,  $5.00 

TEMPERATURE  Charts  for  Recording  Temperature,  Respiration,  Pulse,  Day  of 
Disease,  Date,  Age,  Sex,  Occupation,  Name,  etc.  Put  up  in  pads ;  each  .50 


MEDICAL  AND  SCIENTIFIC  PUBLICA  TIONS.  23 


THOMPSON.  Lithotomy  and  Lithotrity.  Practical  Lithotomy  and  Lithotrity ;  or 
an  Inquir>'  into  the  best  Modes  of  Removing  Stone  from  the  Bladder.  By'  Sir 
Henry  Thompson,  f.r.c.s.,  Emeritus  Professor  of  Clinical  Surgery  in  Univer- 
sity' College.     Third  Edition.     With  87  Engravings.     8vo.  Cloth,  $3.50 

Urinary  Organs.  Diseases  of  the  Urinary  Organs,  Containing  32  Lectures. 
Eighth  London  Ed.    Octavo.     470  pages.  Cloth,  $3.50 

On  the  Prostate.  Diseases  of  the  Prostate.  Their  Pathology  and  Treatment. 
Sixth  London  Edition.     8vo.     Illustrated.  Cloth,  j;2.oo 

Calculous  Diseases.  The  Preventive  Treatment  of  Calculous  Disease,  and 
the  Use  of  Solvent  Remedies.     Third  Edition.        i6mo.  Cloth,  Jti. 00 

Surgery  of  the  Urinary  Organs.  Some  Important  Points  connected  with  the 
Surger)'  of  the  Urinary  Organs.     Illus.  Paper,  .75  ;  Cloth,  ;f  1.25 

THORBURN.  Surgery  of  the  Spinal  Cord.  A  Contribution  to  the  study  of.  By 
William  Thorbukn,  e.s.,  b.Sc,  m.d.,  Lond.,  f.r.c.s.,  Eng.  With  Illustrations. 
Octavo.  Cloth,  $4.50 

THORNTON.  The  Surgery  of  the  Kidney.  By  John  Knowsley  Thornton, 
M.B.  Edin.     With  19  Illustrations.  Cloth,  $1.75 

TILT'S  Change  of  Life  in  Women,  in  Health  and  Disease.  A  Practical  Treatise 
on  the  Diseases  incidental  to  Women  at  the  Decline  of  Life.  By  Edward  John 
Tilt,  m.d.     Fourth  London  Edition.     Svo.  Paper  cover,  .75  ;  Cloth,  $1.25 

TOMES'  Dental  Anatomy.  A  Manual  of  Dental  Anatomy,  Human  and  Compara- 
tive.    By  C.  S.  Tomes,  d.d.s.     212  Illustrations.     3d  Ed.     i2mo.       Cloth,  )j;4.oo 

Dental  Surgery.  A  System  of  Dental  Surgery.  By  John  Tomes,  f.r.s. 
Third  Edition,  Revised  and  Enlarged.  By  C.  S.  Tomes,  d.d.s.  With 
292  Illustrations.     i2mo.     772  pages.  Cloth,  jg5.oo 

TRANSACTIONS  of  the  College  of  Physicians  of  Philadelphia.    Third  Series. 
Vols.  I,  II,  III,  IV,  V,  Cloth,  each,  ^2.50.     VI,  VII,  Cloth,  each,  $3.50. 
Vol.  VIII,  1886,  Cloth,  $3.75.     Vol.  IX,  Cloth,  $2.50. 

TRANSACTIONS  American  Surgical  Association.  Illustrated.  Royal  8vo. 
Price  of  Vol.  I,  II,  III,  IV,  V,  each,  Cloth,  $3.00.  Vol.  VI,  Cloth,  $4.50.  Vol. 
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TREVES.  German-English  Medical  Dictionary.  By  Frederick  Treves,  f.r.c.s., 
assisted  by  Dr.  Hugo  Lang,  b.a.,  (Munich).     i2mo.  yi.  Russian,  ;?3.75 

TRIMBLE.  Practical  and  Analytical  Chemistry.  Being  a  complete  course  in 
Chemical  Analysis.  By  Henry  Trimble,  ph.g..  Professor  of  Analytical  Chem- 
istry in  the  Philadelphia  College  of  Pharmacy.  Third  Edition.  Enlarged. 
Illustrated.     Svo.  Cloth,  ;jti. 50 

TURNBULL'S  Artificial  Anaesthesia.  The  Advantages  and  Accidents  of  Artifi- 
cial Anaesthesia  ;  Its  Employment  in  the  Treatment  of  Disease;  Modes  of  Ad- 
ministration ;  Considering  their  Relative  Risks ;  Tests  of  Purity  ;  Treatment  of 
Asphyxia;  Spasms  of  the  Glottis;  Syncope,  etc.  By  Laurence  Turnhull,  m.d., 
PH.  g..  Aural  Surgeon  to  Jefferson  College  Hospital,  etc.  Tliird  Edition,  Re- 
vised and  Enlarged.     40  Illustrations.     i2mo.  Clolii,  ;il3.oo 

TUSON.  Veterinary  Pharmacopoeia.  Including  the  Outlines  of  Materia  Medica 
and  Therapeutics.  For  the  Use  of  Students  and  Practitioners  of  Veterinary 
Medicine.     By  Richard  V.  Tuson,  F.c.s.     Third  Edition.     i2mo.     Cloth,  #2.50 


24  P.  BLAKISTON,  SON  &-  CO.'S 

TYSOH".  Bright's  Disease  and  Diabetes.  With  Especial  Reference  to  Pathology 
and  Therapeutics.  By  James  Tyson,  m.d.,  Professor  of  Clinical  Medicine  in 
the  University  of  Pennsylvania.  Including  a  Section  on  Retinitis  in  Bright's 
Disease.  By  Wm.  F.  Norris,  m.d.,  Clin.  Prof,  of  Ophthalmology,  in  Univ.  of 
Penna.     With  Colored  Plates  and  many  Wood  Engravings.     8vo.     Cloth,  $3.50 

Guide  to  the  Examination  of  Urine.    Seventh.  E^tion.    For  the  Use  of 

Physicians  and  Students.  With  Colored  Plates  and  Numerous  Illustrations 
Engraved  on  Wood.  Seventh  Edition.  Revised.  i2mo.  255pages.  Cloth,^i.5o 

Cell  Doctrine.  Its  History  and  Present  State.  With  a  Copious  Bibliography 
of  the  subject.     Illustrated.     Second  Edition.     8vo.  Cloth,  |2.oo 

Handbook  of  Physical  Diagnosis.    Illustrated.         Ready  in  October,  i8gi. 

VALENTIN'S  Qualitative  Analysis.  A  Course  of  Qualitative  Chemical  Analysis. 
By  Wm.  G.  Valentin,  f.c.s.  Seventh  Edition.  Illustrated.  Octavo.     Cloth,  $3.00 

VAN  HABLINGEN  on  Skin  Diseases.  A  Practical  Manual  of  Diagnosis  and 
Treatment.  By  Arthur  Van  Harlingen,  m.d..  Professor  of  Diseases  of  the 
Skin  in  the  Philadelphia  Polyclinic ;  Clinical  Lecturer  on  Dermatology  at  Jef- 
ferson Medical  College.  Second  Edition.  Revised  and  Enlarged.  With  Formulas. 
Eight  Colored  and  other  full  page  plates,  and  New  Illustrations.  Cloth,  $2.50 

VAN  NUYS  on  The  ITrine.  Chemical  Analysis  of  Healthy  and  Diseased  Urine, 
Qualitative  and  Quantitative.  By  T.  C.  Van  Nuys,  Professor  of  Chemistry 
Indiana  University.     39  Illustrations.     Octavo,  Cloth,  $2.00 

VIRCHOWS  Post-mortem  Examinations.    A  Description  and  Explanation  of  the 
Method  of  Performing  them  in  the  Dead  House  of  the  Berlin  Charite  Hospital, 
with  especial  reference  to  Medico-legal  Practice.     By  Prof.  Virchow.     Trans- 
lated by  Dr.  T.  P.  Smith.    Third  Edition,  with  Additions.  Cloth,  $1.00 
Cellular  Pathology,  as  based  upon  Physiological  and  Pathological  Histology. 
20  Lectures  delivered  at  the  Pathological  Institute  of  Berlin.     Translated 
from  the  2d  Ed.  by  F.  Chance,  m.d.    134  lUus.    8th  Am.  Ed.     Cloth,  I4.00 

WALSHAM.  Manual  of  Practical  Surgery.  For  Students  and  Physicians.  By 
Wm.  J.  Walsham,  m.d.,  f.r.c.s.,  Asst.  Surg,  to,  and  Dem.  of  Practical  Surg,  in, 
St.  Bartholomew's  Hospital,  Surg,  to  Metropolitan  Free  Hospital,  London.  With 
236  Engravings.     New  Series  of  Manuals.  Cloth,  I3.00  ;  Leather,  I3.50 

WARING.  Practical  Therapeutics.  A  Manual  for  Physicians  and  Students.  By 
Edward  J.  Waring,  m.d.  Fourth  Edition.  Revised,  Rewritten  and  Rearranged 
by  Dudley  W.  Buxton,  m.d..  Assistant  to  the  Professor  of  Medicine,  University 
College,  London.     Crown  Octavo.  Cloth,  I3.00;  Leather,  $3.50 

WARREN.  Compend  Dental  Pathology  and  Dental  Medicine.  Containing  all 
the  most  noteworthy  points  of  interest  to  the  Dental  student.  By  Geo.  W. 
Warren,  d.d.s..  Clinical  Chief,  Penn'a  College  of  Dental  Surgery,  Phila.  Illus. 
Being  No.  ij  f  Quiz- Compend ?  Series.     i2mo.  Cloth,  ^i.oo 

Interleaved  for  the  addition  of  notes,  ^1.25 

WATSON  on  Amputations  of  the  Extremities  and  Their  Complications.  By 
B.  A.  Watson,  a.m.,  m.d..  Surgeon  to  the  Jersey  City  Charity  Hospital  and  to 
Christ's  Hospital,  Jersey  City,  N,  J. ;  Member  of  the  American  Surgical  Associ- 
ation.    250  Wood  Engravings  and  two  Full-page  Colored  Plates.       Cloth,  ^5.50 

Concussions.     An  Experimental  Study  of  Lesions  arising  from  Severe  Con- 
cussions.    8vo.  Paper  cover,  |i.oo 
WATTS'  Inorganic  Chemistry.     A  Manual  of  Chemistry,  Physical  and  Inorganic. 
(Being  the  14th  Edition  of  Fowne's  Physical  and  Inorganic  Chemistry.) 
By  Henry  Watts,  b.a.,  f.r.s..  Editor  of  the  Journal  of  the  Chemical  Society ; 
Author  of  "  A  Dictionary  of  Chemistry,"  etc.     With  Colored  Plate  of  Spectra 
and  other  Illustrations.     i2mo.     595  pages.  Cloth,  ;5S2.25 
Organic  Chemistry.     Second  Edition.     By  Wm.  A.  Tilden,  d.sc,  f.r.s. 
(Being  the  13th  Edition  of  Fowne's  Organic  Chemistry.)     Illustrated. 
i2mo.  Cloth,  j^2.25 


MEDICAL  AND  SCIENTIFIC  PUBLICA  TIONS.  25 


"WHITE.  The  Mouth  and  Teeth.  By  J.  W.  White,  m.d..  d.d.s.  Editor  of  the 
Dental  Cosmos.     Illustrated.  Cloth,  .50 

"WILSON'S  Text-Book  of  Domestic  Hygiene  and  Sanitary  Information.  A  Guide 
to  Personal  and  Domestic  Hygiene.  By  George  Wilson,  m.d.,  Medical  Officer 
of  Health.  Edited  by  Jos.  G.  Richardson,  m.d.,  Professor  of  Hygiene  at  the 
University  of  Pennsylvania.  Cloth,  $1.00 

"WILSON.  Handbook  of  Hygiene  and  Sanitary  Science.  With  Illustrations.  Seventh 
Edition,  Revised  and  Enlarged.     8vo.  In  Press. 

"WILSON.    The  Summer  and  Its  Diseases.    By  James  C.  Wilson,  m.d.    Cloth,  .50 

WINCKEL.  Diseases  of  "Women.  Second  Edition.  Including  the  Dis- 
eases of  the  Bladder  and  Urethra.  By  Dr.  F.  Winckel,  Professor  of 
Gynaecology,  and  Director  of  the  Royal  University  Clinic  for  Women,  in  Munich. 
Translated  by  special  authority  of  Author  and  Publisher,  under  the  supervision 
of,  and  with  an  Introduction  by,  Theophilus  Parvin,  m.d..  Professor  of 
Obstetrics  and  Diseases  of  Women  and  Children  in  Jefferson  Medical  Col- 
lege, Philadelphia.  With  150  Engravings  on  Wood,  most  of  which  are  original 
2d  Edition,  Revised  and  Enlarged.  Cloth,  $3.00;  Leather,  $3.50 

Text-Book  of  Obstetrics  ;  Including  the  Pathology  and  Therapeutics  of  the 
Puerperal  State.  Authorized  Translation  by  J.  Clifton  Edgar,  a.m.,  m.d.. 
Adjunct  Professor  to  the  Chair  of  Obstetrics,  Medical  Department,  University, 
City  of  New  York.  With  nearly  200  Handsome  Illus.,  the  majority  of  which 
are  original  with  this  work.     Octavo.  Cloth,  $6.00;  Leather,  $7.00 

"WOAKES.  Post-Nasal  Catarrh  and  Diseases  of  the  Nose,  causing  Deafness.  By 
Edward  Woakes,  m.d.,  Senior  Aural  Surgeon  to  the  London  Hospital  for 
Diseases  of  the  Throat  and  Chest.     26  Illustrations.  Cloth,  ^1.50 

"WOLFF.  Manual  of  Applied  Medical  Chemistry  for  Students  and  Practitioners  of 
Medicine.  By  Lawrence  Wolff,  m.d.,  Demonstrator  of  Chemistry  in  Jeffer- 
son Medical  College,  Philadelphia.  Cloth,  $1.00 

"WOOD.  Brain  "Work  and  Overwork.  By  Prof.  H.  C.  Wood,  Clinical  Professor 
of  Nervous  Diseases,  University  of  Pennsylvania.     i2mo.  Cloth,  .50 

"WOODY.  Essentials  of  Chemistry  and  Urinalysis.  By  Sam  E.  Woody,  a.m., 
m.d..  Professor  of  Chemistry  and  Public  Hygiene,  and  Clinical  Lecturer  on 
Diseases  of  Children,  in  the  Kentucky  School  of  Medicine.  Third  Edition. 
Illustrated.     i2mo.  Cloth,  gi.25 

"WYNTER  and  "WETHERED.  Clinical  and  Practical  Pathology.  A  Manual 
of  Clinical  and  Practical  Pathology.  By  W.  Essex  Wvntick,  m.d.,  Medical  Reg- 
istrar and  late  Dem.  of  Anat,  and  Chem.  at  the  Middlesex  Hospital,  and 
Frank  J.Wethered,  m.d.,  Asst.  Phys.  to  the  City  of  London  Hospital  for  Dis. 
of  the  Chest.     4  Colored  Plates  and  67  other  Illustrations.     8vo.         Cloth,  54.00 

"WYTHE.  Dose  and  Symptom  Book.  The  Physician's  Pocket  Dose  and  Symptom 
Book.  Containing  the  Doses  and  Uses  of  all  the  Principal  Articles  of  the 
Materia  Medica,  and  Officinal  Preparations.  By  Joseph  H.  Wythe,  a.m.,  m.d. 
17th  Edition,  Revised  and  Rewritten. 

Cloth,  SSi.oo;  Leather,  with  Tucks  and  Pocket,  JS1.25 

YEO'S  Manual  of  Physiology.  Fifth  Edition.  A  Text-book  for  Students  of 
Medicine.  By  Gerald  F.  Yeo.,  m.d.  f.r.c.s.,  Professor  of  Physiology  in  Kind's 
College,  I^ndon.  Fifth  Edition;  revised  and  enlarged  by  the  author.  With 
321  Wood  Plngravings  and  a  Glossary.  Crown  Octavo.  Beitu;  No.  4,  N,"w 
Series  of  Manuals.  Cloth,  ;?3.oo  ;  Leather,  ^^3.50. 


New  Series  of  Manuals. 

FOR  MEDICAL  STUDENTS  AND  PHYSICIANS. 

Demi-Octavo.    Price  of  each  book,  Cloth,  $3.00 ;  Leather,  $3.50. 

The  object  held  in  view  in  the  preparation  of  this  Series  was  to  make  books  that  should  be  concise  and 
practical,  not  burdened  by  useless  theories  and  discussions,  but  containing  all  that  is  needed  or  necessary  for 
the  student  and  practitioner.  IvTo  pains  have  been  spared  to  bring  them  up  to  the  times,  and  the  very  low 
price  at  which  they  have  been  published  is  an  additional  point  in  their  favor.  Full  circular,  descriptive  of 
the  Series,  will  be  sent  upon  application. 

WALSHAMS  PRACTICAL  SURGERY.  A  Manual  for  Students  and  Physicians.  By  Wm.  J. 
Walsham,  M.D.,  Asst.  Surgeon  to,  and  Demonstrator  of  Surgery  in,  St.  Bartholomew's  Hospital;  Sur- 
geon to  Metropolitan  Free  Hospital,  London,  etc.     236  Illust.     656  pp. 

Cloth,  $3.00 ;  Leather,  ^3.50 
From  the  Polyclinic. 

"  While  evidently  intended  to  be  a  text-book  for  students,  and  therefore  small  in  size  and  compactly  written,  is  neverthe- 
less full  enough  for  the  use  of  those  practitioners  who  desire  a  short  account  of  the  various  surgical  principles  and  operations 
involved  in  the  treatment  of  the  ordinary  run  of  surgical  cases.  The  author  seems  to  be  a  conservative  and  judicious  surgeon 
with  advanced  ideas.'' 

PARVIN'S-WINCKEL'S  DISEASES  OF  WOMEN.  Second  Edition.  A  Treatise  on  the  Dis- 
eases  of  Women.  Including  the  Diseases  of  the  Bladder  and  Urethra.  By  Dr.  F.  Winckel,  Professor 
of  Gynaecology  and  Director  of  the  Royal  University  Clinic  for  Women,  in  Munich.  Revised  and  Edited 
by  Theophilus  Parvin,  m.d.,  Professor  of  Obstetrics  and  Diseases  of  Women  and  Children  in  Jeffer- 
son Medical  College.     Illustrated  by  150  fine  Engravings  on  Wood,  most  of  which  are  new.     760  pp. 

Cloth,  ^3.00;  Leather,  ;jS3. 50 

GALABIN'S  MIDWIFERY.  A  Manual  of  Widwifery.  By  Alfred  Lewis  Galabin,  m.a.,  m.d., 
Obstetric  Physician  and  Lecturer  on  Midwifery  and  the  Diseases  of  Women  at  Guy's  Hospital,  London; 
Examiner  in  Midwifery  to  the  Conjoint  Examining  Board  of  England.     227  Illustrations.     753  pages. 

Cloth,  ^3.00;  Leather,  ^3.50 

FroJit  The  Archives  of  Gyncecology ,  New  York. 

"  The  illustrations  are  mostly  new  and  well  executed,  and  we  heartily  commend  this  book  as  far  superior  to  any  manual 
upon  this  subject." 

YEO'S  MANUAL  OF  PHYSIOLOGY.  Fifth  Edition.  A  New  Text-book  for  Students.  Byj 
Gerald  F.  Yeo,  m.d.,  f.r.c.s..  Professor  of  Physiology  in  King's  College,  London.  321  Illustra-| 
tions  and  a  Glossary.     758  pages.  Cloth,  ;^3. 00 ;  Leather,  ^3.501 

From  Prof.  Lewis  A.  Stimson,  M.D.,  57  East  33d Street,  New  York. 

"  The  brief  examination  I  have  given  it  was  so  favorable  that  I  placed  it  in  the  list  of  text-books  recommended  in  the  cir- 
cular of  the  University  Medical  College." 

GOODHARTAND  STARR,  DISEASES  OF  CHILDREN.  Second  Edition.  By  J.  F.  Goodhart, 
M.D.,  Physician  to  the  Evelina  Hospital  for  Children ;  Assistant  Physician  to  Guy's  Hospital,  London. 
Second  American  from  third  English  Edition.  Revised  and  Edited  by  Louis  Starr,  m.d.,  Clinical 
Professor  of  Diseases  of  Children  in  the  Hospital  of  the  University  of  Pennsylvania,  and  Physician  to  the 
Children's  Hospital,  Phila.  With  many  new  Prescriptions  and  Directions  for  making  Artificial  Human 
Milk,  for  the  Artificial  Digestion  of  Milk,  etc.     760  pages.  Cloth,  ^3.00;  Leather,  ^3.50 

From  The  New  York  Medical  Record. 

"  As  it  is  said  of  some  men,  so  it  might  be  said  ot  some  books,  that  they  are  '  born  to  greatness.'    This  new  volume  has 

we  believe,  a  mission,  particularly  in  the  hands  of  the  young  members  of  the  profession.     In  these  days  of  prolixity  in  medical 

literature,  it  is  refreshing  to  meet  with  an  author  who  knows  both  what  to  say  and  when  he  has  said  it." 

WARING'S  PRACTICAL  THERAPEUTICS.  Fourth  Edition.  A  Manual  of  Practical  Thera- 
peutics, considered  with  reference  to  Articles  of  the  Materia  Medica.  Containing,  also,  an  Index  of 
Diseases,  with  a  list  of  Medicines  applicable  as  Remedies,  and  a  fall  Index  of  the  Medicines  and 
Preparations  noticed  in  the  work.  By  Edward  John  Waring,  m.d.,  f.r.c.p.,  f.l.s.,  etc.  4th 
Edition.  Rewritten  and  Revised.  Edited  by  Dudley  W.  Buxton,  m.d.,  Asst.  to  the  Prof,  of  Medicine 
at  University  College  Hospital;  Member  of  the  Royal  College  of  Physicians  of  London.     666  pages. 

Cloth,  ^3.00;  Leather,  ^3,50  jj 

From  The  Kansas  City  Medical  Record.  i 

"  As  a  work  of  reference  it  excels,  on  account  of  the  several  complete  indexes  added  to  this  edition.     It  was  deservedly 

popular  in  former  editions,  and  will  be  more  so  in  the  one  before  us,  on  account  of  the  careful  arrangement  of  the  subjects." 

REESE'S  MEDICAL  JURISPRUDENCE  AND  TOXICOLOGY.  Third  Edition.  By  John, 
J.  Reese,  m.d.,  Professor  of  Medical  Jurisprudence  and  Toxicology  in  the  University  of  Pennsylvania;! 
late  President  of  the  Medical  Jurisprudence  Society  of  Philadelphia ;  Physician  to  St.  Joseph's  Hospital;! 
Member  of  the  College  of  Physicians  of  Phila.;  Corresponding  Member  of  the  New  York  Medico-Legal  ' 
Society,  etc.     Third  Edition.     Revised  and  Enlarged.     666  pages.  Cloth,  ^3.00 ;  Leather,  ^3.50 

From  The  American  Journal  0/  Medical  Sciences. — "  This  admirable  text-book." 
From  Cincinnati  Lancet  and  Clinic. 

"  We  lay  this  volume  aside,  after  a  careful  perusal  of  its  pages,  with  the  profound  impression  that  it  should  be  in  the  hands 
of  every  doctor  and  lawyer.  It  fully  meets  the  wants  of  all  students.  .  .  .  He  has  succeeded  in  admirably  condensing  into 
a  handy  volume  all  the  essential  points." 

THE  MOST  PRACTICAL  SERIES  OF  TEXT-BOOKS.  i 


PHYSIOLOGY. 


Landois.     A  Text-Book  of  Human  Physiology.    Third 
Edition.     692  Illustrations.  1889. 

INCLUDING  HISTOLOGY  AND  MICROSCOPICAL  ANATOM\^ 

with  special  reference  to  the  requirements  of  Practi- 
cal Medicine.  By  Dr.  L.  Landois,  Professor  of 
Physiology  and  Director  of  the  Physiological  Insti- 
tute in  the  University  of  Greifswald.  Third  Ameri- 
can, translated  from  the  Sixth  German  Edition,  with 
additions,  by  Wm.  Stirling,  m.d.,  d.Sc,  Bracken- 
bury  Professor  of  Physiology  and  Histology  in  Owens 
College,  Manchester;  Examiner  in  Physiology  in 
University  of  Oxford.  With  692  Illustrations.  En- 
larged, Revised  and  Improved.  Royal  Octavo. 
One  Volume.  Cloth,  $6.50;  Leather,  $7.50 

*^*  The  practical  value  of  this  book  to  the  physician 
can  scarcely  be  over-estimated.  It  is  not  a  text-book  as 
the  term  is  generally  understood,  but  a  treatise  on  Phy- 
siology in  its  relations  to  practical  medicine,  and  in- 
cludes much  clinical  information. 

"  It  is  the  most  complete  and  satisfactory  text-book  on  physiology 
extant.  The  translator  and  publisher  have  each  done  something  to 
increase  the  value  of  the  volume.  Dr.  Stirling  has  added  numerous 
useful  annotations  and  a  large  number  of  new  plates.  .  .  .  We 
wish  that  every  medical  student  and  physician  could  be  drilled  on 
these  volumes." — The  N.  V.  Medical  Record. 


SPECIMEN   OP   ILLUSTKATIONS. 


Yeo's  Manual  of  Physiology.      Fifth  Edition.        1891.. 

A  TEXT-BOOK  FOR   STUDENTS  OF   MEDICINE.       By 

Gerald  F.  Yeo,  m.d.,  f.r.c.s..  Professor  of 
Physiology  in  King's  College,  London,  Fifth 
Edition.  With  New  Illustrations.  321  Wood 
Engravings  and  a  Glossary.  Crown  Octavo. 
Being  No.  4,  New  Series  of  Manuals. 

Cloth,  $3.00;  Leather,  ^3.50 

*5j;*  This  volume  was  specially  prepared  to  furni.sh 
a  new  text-book  of  Physiology,  elementary  so  far  as  c* 
to  avoid  theories  which  have  not  borne  the  test  of 
time  and  such  details  of  methods  as  are  unnecessary 
for  students.  While  endeavoring  to  save  the  student 
from  doubtful  and  erroneous  doctrines,  great  care  has 
been  taken  not  to  omit  any  important  facts  that  are 
neces.sary  to  an  acquirement  of  a  clear  idea  of  the 
principles  of  Physiology.  Such  subjects  as  are  useful 
in  the  practice  of  medicine  and  surgery  are  treated 
more  fully  than  those  which  are  essential  only  to  an 
abstract  physiological  knowledge.  A  book  in  every 
way  suited  for  student's  u.se. 

"  Dr.  Yeo's  manual  has  reached  the  position  of  Ijeing,  we 
believe,  the  licst  by  far  of  the  smaller  text-lxxjks  on  I'hysiology." 
—  Tlurapeutic  Gazette, 


&CA 


■raCIMIM   nr    ILLU^TKATIUN*. 


r 


PRACTICE  OF  MEDICINE. 

Taylor.     Practice  of  Medicine.  1890. 

A  MANUAL  OF  THE  PRACTICE  OF  MEDICINE.       By   FREDERICK  TaYLOR,  M.  D.,  Physician 

to,  and  Lecturer  on  Medicine  at,  Guy's  Hospital,  London;  Physician  to  the  Evelina 
Hospital  for  Sick  Children  ;  Examiner  in  Materia  Medica  and  Pharmaceutical  Chem- 
istry, at  the  University  of  London.  Cloth,  ^4.00;  Leather,  ^5.00 

"  By  consulting  the  most  recent  works,  especially  those  of  Fagge,  Striimpell,  Payne, 
Ziegler,  Gowers,  M.  Mackenzie,  Douglas  Powell,  Ralfe,  H.  Morris  and  Crocker,  to 
whom  I  must  express  my  indebtedness,  I  have  sought  to  bring  this  book  fully  up  to  the 
modern  state  of  knowledge.  I  have  not,  however,  devoted  much  space  to  the  discussion 
of  theories,  finding  that  the  facts  of  medicine  are  amply  sufficient  to  fill,  and  more  than 
fill,  a  volume  such  as  this,  and  being  convinced  that  these  facts  require  to  be  seized  and 
held  fast  by  the  beginners  in  medicine,  not  only  for  the  sake  of  diagnosis  and  treatment, 
but  also  for  the  right  estimation  of  the  various  theories  which  are  advanced.  With  a 
brief  statement,  therefore,  of  such  views  I  have  in  most  cases  been  content. ' ' 

"  It  is  an  entirely  original  work,  by  one  accustomed  to  teacli  his  subject  both  didactically  and  clinically, 
who  knows  and  understands  how  to  present  to  the  reader  both  the  essential  elements  and  the  endless  details 
of  the  science  and  art  of  medicine.  How  well  Dr.  Frederick  Taylor  has  performed  his  task,  may  be  learned 
almost  ad  aperturam.  .  .  .  The  author  has  taken  great  pains  to  embody  in  this  work  the  latest  advances 
in  our  knowledge  of  the  nature  and  treatment  of  disease.  We  find,  for  example,  accounts  of  actinomycosis 
and  the  use  of  suspension,  and  even  of  the  epidemic  of  Russian  influenza  which  swept  over  Europe  last 
winter. 

"  We  have  noted  with  particular  care,  and  we  will  say  with  particular  approval,  the  extremely  sensible 
remarks  which  Dr.  Taylor  has  given  us  under  the  head  of  treatment.  In  some  respects  the  sections  on  treat- 
ment must  have  been  the  most  difficult  part  to  write  of  a  short  treatise  on  the  practice  of  medicine.  Manifestly 
the  first  and  the  chief  end  to  be  attained,  is  the  inculcation  of  sound  therapeutical  principles.  But  in  the 
second  place,  the  students  and  young  practitioner  must  have  something  concrete  supplied  to  them,  in  the 
shape  of  details  to  which  they  can  refer,  when  they  are  either  following  the  practice  of  their  teachers  or  find 
themselves  face  to  face  with  patients  of  their  own.  Dr.  Taylor  has  succeeded  admirably  in  fulfilling  both 
these  indications,  if  we  may  borrow  what  is  itself  a  therapeutical  phrase." — The  Practitioner,  London,  Sep- 
tember, 1890. 

"  Sedatives,  Dr.  Taylor  further  says,  in  speaking  of  capillary  bronchitis,  must  be  given  with  the  greatest 
caution,  or  entirely  avoided,  for  the  reasons  given.  In  referring  to  the  treatment  of  chronic  bronchitis  the 
author  recommends,  among  other  good  agents,  turpentine,  copaiba,  and  the  more  modem  drug — terebene. 
This  will,  on  examination,  be  found  to  abound  in  very  many  such  practical  observations,  making  the  manual 
of  great  service  to  the  physician." — Medical  Bulletin,  Philadelphia,  January,  1891. 

"  Dr.  Taylor  has  given  us  a  very  valuable  work.  We  are  pleased  to  miss  the  long  and  interminable 
dissertations  on  etiology  and  pathological  anatomy,  these  subjects  being  clearly  and  briefly  stated.  On  the 
other  hand,  the  pages  of  the  book  are  mostly  taken  up  with  the  subjects  of  symptoms,  diagnosis,  prognosis  and 
treatment,  all  of  the  utmost  importance  in  actual  practice.  The  work  is  up  to  date  in  all  essential  particulars  of 
medical  advance.    This  is  one  of  the  books  to  buy  for  this  season." — Medical  World,  Phila.,  December,  1890. 

"  We  have  already  spoken  in  warm  praise  of  the  book,  and  have  only  to  add  that  it  is  just  the  one  to  put 
in  the  hands  of  a  student  who  wishes  to  read  up  a  subject  while  he  is  listening  to  lectures  on  practice ;  it  is 
full  enough  to  be  clear,  without  being  full  enough  to  confuse." — Medical  and  Surgical  Reporter,  Y)aS\aAA- 
phia,  January,  1 891. 

"  The  book  is  just  such  a  one  as  may  lead  the  student  to  regard  the  mastery  of  medical  science  as  an  easy 
task,  the  subtle  and  obscure  points  having  been  placed  in  the  background.  It  seems  to  us  that  in  this  the  author 
has  acted  well.  We  know  of  no  work  that,  while  being  satisfactorily  full,  addresses  itself  more  readily  to  the 
understanding  than  does  this.  When  this  is  mastered,  the  student  will  feel  encouraged  for  greater  tasks, 
instead  of  being  disheartened  and  having  his  ardor  disappointed  at  the  very  threshold  of  his  studies." — 
Ainerican  Practitioner  and  News,  January  3d,  1 89 1. 

"  So  far  as  we  are  informed,  this  is  the  first  instance  in  which  Dr.  Taylor  has  come  before  the  Medical 
World  as  an  author.  His  reputation  as  a  teacher  and  practitioner  has,  for  some  time,  been  an  enviable  and 
extensive  one.  Many  candidates  for  degrees,  and  many  now  in  the  ranks  of  the  profession,  can  testify  to  his 
knowledge  of  medicine  and  his  efficiency  in  his  practice.  His  literary  effort  now  just  being  presented  deser\'es 
respect  and  fair  examination  on  account  of  the  author's  record  and  position,  irrespective  of  its  intrinsic  worth. 
But  the  book,  we  are  convinced,  has  merits  that  will  gain  for  it  recognition,  even  if  its  author  were  unknown 
or  nameless.  It  is  a  handbook  on  the  practice  of  medicine,  from  which  theory  and  superfluity  have  been 
eliminated,  and  facts  of  practical  utility  alone  recognized." — Pacific  Medical  Journal,  San  Francisco,  Feb- 
ruary, 2d,  1 89 1. 

"  On  the  whole,  we  think  it  would  be  difficult  to  find  another  work  on  the  same  subject,  which  contained 
in  a  similar  space  so  much  information.  Dr.  Taylor's  style  of  writing,  too,  is  clear  and  readable,  and  we  feel 
sure  that  his  book  will  be  widely  read  and  appreciated." — The  Dublin  Journal  of  Medical  Science, 


NEW  AND  REVISED  EDITIONS. 

PQUIZ-COMPENDS.? 

A  SERIES  OF  PRACTICAL  MANUALS  FOR  THE  PHYSICIAN  AND  STUDENT. 

Compiled  in  accordance  with  the  latest  teachings  of  prominent  lecturers 
and  the  most  popular  Text-books. 

Bound  in  Cloth,  each  $i.oo.    Interleaved,  for  the  Addition  of  Notes,  $1.25. 

They  form  a  most  complete,  practical  and  exhaustive  set  of  manuals,  containing  information  nowhere  else 
collected  in  such  a  practical  shape.  Thoroughly  up  to  the  times  in  every  respect,  containing  many  new  pre- 
scriptions and  formulae,  and  over  300  illustrations,  many  of  which  have  been  drawn  and  engraved  specially  for 
this  series.  The  authors  have  had  large  experience  as  quiz-masters  and  attaches  of  colleges,  with  exceptional 
opportunities  for  notmg  the  most  recent  advances  and  methods.  The  arrangement  of  the  subjects,  illustrations, 
types,  etc.,  are  all  of  the  most  approved  form.  They  are  constantly  being  revised,  so  as  to  include  the  latest 
and  best  teachings,  and  can  be  used  by  students  of  any  college  of  medicine,  dentistry  and  pharmacy. 

No.  I.  Human  Anatomy.  Fifth  Edition  (1891),  including  Visceral  Anatomy,  formerly  pub- 
lished separately.  16  Lithograph  Plates,  Tables,  and  117  Illustrations.  By  Samuel  O.  L. 
Potter,  m.a.,  m.d.,  late  A.  A.  Surgeon,  U.  S.  Army.  Professor  of  Practice,  Cooper  Med.  College^ 
San  Francisco. 

Nos.  2  and  3.  Practice  of  Medicine.  Fourth  Edition,  Enlarged  (1890).  By  Daniel  E.  Hughes,. 
M.D.,  late  Demonstrator  of  CUnical  Medicine  in  Jefferson  Med.  College,  Phila. ;  Physician-in- Chief,  Phila- 
delphia Hospital.     In  two  parts. 

Part  I. — Continued,  Eniptive  and  Periodical  Fevers,  Diseases  of  the  Stomach,  Intestines,  Peritoneum,  Biliary  Passages, 
Liver,  Kidneys,  etc.  (including  Tests  for  Urine),  General  Diseases,  etc. 

Part  II. — Diseases  of  the  Respiratory  System  (including  Physical  Diagnosis),  Circulatory  System  and  Nervous  System; 
Diseases  of  the  Blood,  etc. 

***  These  little  books  can  be  regarded  as  a  full  set  of  notes  upon  the  Practice  of  Medicine,  containing  the  Synonyms, 
Definitions,  Causes,  Symptoms,  Prognosis,  Diagnosis,  Treatment,  etc.,  of  each  disease,  and  including  a  number  of  prescrip- 
tions hitherto  unpublished. 

No.  4.  Physiology,  including  Embryology.  Sixth  Edition  (1891).  By  Albert  P.  Brubaker,  m.d., 
Prof  of  Physiology,  Penn'a  College  of  Dental  Surgery;  Demonstrator  of  Physiology  in  Jefferson  Med. 
College,  Phila.     Revised,  Enlarged  and  Illustrated.  In  Press. 

No.  5.  Obstetrics.  Illustrated.  Fourth  Edition  (1889).  For  Physicians  and  Students.  By  Henry 
G.  Landis,  m.d.,  Prof  of  Obstetrics  and  Diseases  of  Women,  in  Starling  Medical  College,  Columbus. 
Revised  Edition.     New  Illustrations. 

No.  6.  Materia  Medica,  Therapeutics  and  Prescription  Writing.  Fifth  Revised  Edition  (1S91). 
With  especial  Reference  to  the  Physiological  Action  of  Drugs,  and  a  complete  article  on  Prescription 
Writing.  Based  on  the  Last  Revision  (Sixth)  of  the  U.  S.  Pharmacopoeia,  and  including  many  unofificinal 
remedies.  By  Samuel  O.  L.  Potter,  m.a.,  m.d.,  late  A.  A.  Surg.  U.  S.  Army;  Prof  of  Practice, 
Cooper  Med.  College,  San  Francisco.     5th  Edition.     Improved  and  Enlarged. 

No.  7.  Gynaecology.  (1891.)  A  Compend  of  Diseases  of  Women.  By  Henry  MORRIS,  M.D.,  Demon- 
strator of  Obstetrics,  Jefferson  Medical  College,  Philadelphia.     Many  Illustrations. 

No.  8.  Diseases  of  the  Eye  and  Refraction.  Second  Edition  (1888).  Including  Treatment  and 
Surgery.  By  L.  Webster  Fox,  m.d..  Chief  Clinical  Assistant  Opthalmological  Dept.,  Jefferson  Medical 
College,  etc.,  and  Geo.  M.  Gould,  m  d.     71  Illustrations,  39  Formulae. 

No.  9.  Surgery,  Minor  Surgery  and  Bandaging.  Illustrated.  Fourth  Edition  (1890).  Including 
Fractures,  Wounds,  Dislocations,  Sprains,  Amputations  and  other  operations ;  Inflammation,  Suppuration, 
Ulcers,  Syphilis,  Tumors,  Shock,  etc.  Diseases  of  the  Spine,  Ear,  Bladder,  Testicles,  Anus,  and  otlier 
Surgical  Diseases.  By  Orville  Horwitz,  a.m.,  m.d..  Demonstrator  of  Surgery,  Jefferson  Medical 
College.     84  Formulae  and  136  Illustrations. 

No.  10.  Medical  Chemistry.  Third  Edition  (1890).  Inorganic  and  Organic,  including  Urine  Analysis. 
For  Medical  and  Dental  Students.  By  Henry  Leffmann,  m.d..  Prof,  of  Chemistry  in  Penn'a  College 
of  Dental  Surgery,  Phila.     Third  Edition.     Revised  and  Enlarged. 

No.  II.  Pharmacy.  Third  Edition  (1890).  Based  upon  "  Remington's  Text-Book  of  Pharmacy."  By 
F.  E.  Stewart,  m.d.,  ph.g..  Professor  of  Pharmacy,  Powers  College  of  Pharmacy;  late  Quiz-Master  at 
Philadelphia  College  of  Pharmacy.     Third  Edition.     Revised. 

No.  12.  Veterinary  Anatomy  and  Physiology.  Illustrated.  (1890.)  By  Wm.  R.  Ballou,  M.D.,  Prof 
of  Equine  Anatomy,  New  York  College  of  Veterinary  Surgeons,  etc.     29  Illustrations. 

No.  13.  Dental  Pathology  and  Dental  Medicine.  (1890.)  Containing  all  the  most  noteworthy  points 
of  interest  to  the  Dental  Student.  By  Geo.  W.  Warren,  d.d.s..  Clinical  Chief,  Penn'a  College  of 
Dental  Surgery,  Philadelphia.     Illus.  ,/-,•,, 

No.  14.  Diseases  of  Children.  (1890.)  By  Marcus  P.  Hatfield,  Professor  of  Diseases  of  Children,. 
Chicago  Medical  College.     With  Colored  Plate. 

JJI^-  These  books  are  constantly  revised  to  keep  up  with  the  latest  teachings  and  discoveries. 


Fro,m  The  Southern  Clinic.—"  We  know  of  no  series  of  books  issued  by  any  house  that  so 
fully  meets  our  approval  as  these  ?  Quiz-  Compends  ?  They  are  well  arranged,  full  and  concise, 
and  are  really  the  best  line  of  text-books  that  could  be  found  for  cither  student  or  practitioner. 


NERVOUS  AND  MENTAL  DISEASES. 


Gowers'  Diseases  of  the  Nervous  System, 
tion. 


Second  Edi- 
1891. 

A   COMPLETE   MANUAL   OF   THE   DISEASES   OF   THE   NERVOUS   SYSTEM.       By  WiLLIAM   R. 

GowERS,  M.D.,  F.R.C.P.,  Lond.,  Prof.  Clinical  Medicine,  University  College,  London ; 
Physician  to  National  Hospital  for  the  Paralyzed  and  Epileptic ;  late  Physician 
University  College,  London,  etc.  With  about  375  Illustrations,  including  over  600 
Different  Figures.     In  Two  Handsome  Octavo  Volumes.     1600  pages. 

Vol.  I,  Nearly  Ready.     Vol.  11,  Ready  September. 

=^^*The  first  American  edition  of  this  book,  which  was  published  in  one  rather 
unwieldy  volume,  was  completely  exhausted  within  eighteen  months.  In  printing  the 
second,  it  has  been  thought  best  to  follow  the  style  adopted  by  the  English  publishers, 
and  issue  it  in  two  volumes.  In  this  form  it  will  be  much  handier  for  reading  and  refer- 
ence. Dr.  Gowers  has  devoted  a  great  deal  of  time  and  work  in  the  revising;  many 
sections  have  been  rewritten,  and  the  new  matter  will  amount  to  about  100  pages,  includ 
ing  an  important  chapter  on  Multiple  Neuritis,  of  which  no  good  account  exists,  and  a 
number  of  new  illustrations. 


SPECIMEN  OF  ILLUSTRATIONS — FLEXOR  CONTRACTION  OF  LEGS  IN  MYELITIS   OF  THE  DORSAL  REGION. 

A  large  number  of  the  illustrations  are  original,  having  been  made  from  special  draw 
ings  or  from  photographs  of  cases ;  they  not  only  serve  to  illustrate  the  text,  but  will  be 
found  of  great  value  in  the  diagnosing  of  obscure  cases. 

PRESS  NOTICES  OF  FIRST  EDITION. 

"  It  may  be  said,  without  reserve,  that  this  work  is  the  most  clear,  concise  and  complete  text-book  upor 
diseases  of  the  nervous  system  in  any  language.  And  when  the  large  number  of  such  works  which  has 
appeared  in  Germany,  France  and  England  within  the  past  ten  years  is  considered,  this  implies  high  praise.' 
—  The  Afnerican  Journal  of  Medical  Science. 

"  Taken  as  a  whole,  it  promises  to  be  the  most  useful  work  on  diseases  of  the  nervous  system  which  we 
possess." — The  Dtiblin  Journal  of  Medical  Sciences. 

"  The  student  and  practitioner  will  find  in  it  a  true  friend,  guide  and  helper  in  his  studies  of  the  diseases' 
of  the  nervous  system.  It  is  a  most  complete  manual,  presenting  a  thorough  reflex  of  the  present  state  of 
knowledge  of  the  diseases  of  the  nervous  system.  The  care  and  thought  that  have  been  bestowed  on  its  pro 
duction  are  evident  on  every  page.  In  the  presence  of  such  ability,  learning  and  originality,  criticism  can  only 
take  a  favorable  direction.  The  style  and  manner  are  accurate,  studied  and  adequate — never  diffuse.  The 
illustrations  call  for  special  notice.  They  are  numerous,  new  and  original.  No  better  manual  on  nervous 
diseases  has  been  presented  to  the  medical  profession." — The  London  Lancet. 

"  Gowers'  manual  is  herewith  recommended  to  the  general  and  to  the  special  student.  It  is  not  too' 
detailed  for  the  former,  while  for  the  specialist  it  is  explicit  enough  as  a  first-class  book  of  reference.  It  is,  on 
the  whole,  an  admirable  treatise." — The  Journal  of  Nei-vous  and  Mental  Diseases,  New  York. 


BY   THE   SAME   AUTHOR. 


i 


Diseases  of  the  Brain.     Lectures  on  Diagnosis  of  Diseases  of  the  Brain,  delivered  at 
University  College  Hospital.    Second  Edition.    Illustrated.     8vo.  Cloth,  ;g2.oo 


Now  Ready  for  1892.    415?  Year. 

The  PHYSICIAN'S  Visiting  List. 

(LINDSAY  &  BLAKISTON'S.) 

CONTENTS. 

Almanac  for  1892  and  1893;  Table  of  Signs  to  be  used  in  keeping  accounts;  Marshall  Hall's  Ready 
Method  in  Asphyxia;  Poisons  and  Antidotes,  revised  for  1892;  The  Metric  or  French  Decimal  System  of 
Weights  and  Measures;  Dose  Table,  revised  and  rewritten  for  1892;  List  of  New  Remedies  for  1692;  Aids 
to  Diagnosis  and  Treatment  of  Diseases  of  the  Eye ;  Diagram  Showing  Eruption  of  Milk  Teeth,  Dr.'louis 
Starr;  Posological  Table;  Disinfectants  and  Disinfecting;  Examination  of  Urine,  Dr.  J.  Daland, /;(7.t<f(/ 
upon  Tyson  s  "  Practical  Examination  of  Urine"  ;  Incompatibility,  Dr.  S.  O.  L.  Potter;  A  New  Complete 
Table  for  Calculating  the  Period  of  Utero- Gestation ;  Sylvester's  Method  for  Artificial  Respiration,  Illustrated; 
Diagram  of  the  Chest;  Blank  Leaves,  suitably  ruled,  for  Visiting  Lists,  Monthly  Memoranda,  Addresses  of 
Patients  and  others ;  Addresses  of  Nurses,  their  references,  etc.;  Accounts  asked  for ;  Memoranda  of  Wants ; 
Obstetric  and  Vaccination  Engagements ;  Record  of  Births  and  Deaths ;  Cash  Account,  etc. ;  Special  Pencil 
with  Rubber  Tip. 

TTiis  Visiting  List  is  published  in  N'oveviber  of  each  year, 

SIZES  AND  PRICES. 


REGULAR  EDITION. 

For  25  Patients  weekly.         Tucks,  pockets  and  Pencil, 


75 
100 


50 
100 


For  25  Patients  weekly. 

50 


fjan.  to  June)   ,,  ,, 

I  July  to  Dec.  J 

I  Jan.  to  June  )   ,,  „ 

July  to  Dec.  J 

INTERLEAVED   EDITION. 

Interleaved,  tucks  and  Pencil, 


^^°'-{]uryto&c1" 


gi.oo 

1.25 
1.50 

2.00 
2.50 


125 

1.50 

3.00 


PERPETUAL  EDITION,  without  Dates. 

No.  I.  Containing  space  for  over  1300  n.Tmes,  with 
blank  page  opposite  each  Visiting  List  page. 
Bound  in  Red  Leather  cover,  with  pocket  and 
Pencil, 51.25 

No.  2.  Containing  space  for  2600  names,  with  blank 
page  opposite  each  Visiting  List  page.  Bound 
like  No.  I,  with  Pocket  and  Pencil,        •        .     1.50 

MONTHLY  EDITION,  without  Dates. 

No.  I.     Bound,  Seal  leather,  without   Flap  or  Pencil, 

gilt  edges, 75 

No.  2.     Bound,  Seal  leather,  with  Tucks,  Pencil,  etc., 

gilt  edges, i.oo 


SPECIAL  SIZES   AND   BINDINGS   MADE  TO   ORDER. 


PRESS  NOTICES  OF  EDITION  FOR  1891. 


"  Nothing  can  seem  better  fitted  to  meet  the  purpose  for 
which  they  are  designed  than  these  Visiting  Lists  of 
Messrs.  Blakiston,  and  the  forty  years  of  patronage  they 
have  enjoyed  must  have  convinced  public  and  publisher 
alike  of^  their  value.  We  not  only  have  the  convenient 
arrangement  for  keeping  visiting  accounts,  but  a  fund  of 
useful  information  of  all  kinds,  embracing  dose  tables, 
weights  and  measures,  posological  tables,  disinfectants, 
urinary'  analysis,  poisons  and  antidotes,  etc.,  all  arranged 
for  ready  reference  in  a  well  bound  leather  book  that  can 
at  all  times  be  carried  in  the  coat  pocket.  These  books 
are  complete,  comprehensive,  and  convenient." — The 
Physician  and  Surgeon,  Ann  Arbor,  Mich. 

"  It  has  long  been  known  to  the  profession,  and  needs  no 
further  notice  than  to  say  that  it  maintains  the  standard 
of  excellence  acquired  by  its  predecessors." — JVezv  Orleans 
Medical  and  Surgical  Journal. 

"  This  oldest  and  best  known  of  the  Visiting  Lists 
comes  with  the  new  year  unchanged  in  form,  and  with 
such  alterations  in  contents  only  as  were  called  for  by 
recent  therapeutic  advance.  In  compactness,  neatness, 
and  completeness  it  is  a  marvel." — American  Practitioner 
and  Neu/s,  Louisville. 

"  This  is  the  thirtv-ninth  year  of  the  publication  of  this 
neat,,  compact,  ana  universally-acknowlcdged-to-be  the 
best  of  its  kind  published.  It  has  stood  the  test  of  time 
and  finds  ready  sale  from  a  simple  announcement  that  it  is 
ready  " — 7'he  Medical  Brief  ,  St.  I-Muis. 

"  The  best  endorsement  I  can  ^ive  of  my  appreciation 
of  the  Lindsay  &  Blakiston  Visilmg  List  is,  that  I  have 
been  using  it  from  its  first  issue  and  find  it  is  the  best  in 
use."— C».  F.  Potter,  M.D.,  St.  Louis. 


"  This  is  the  eleventh  year  that  we  are  using  this  Visit- 
ing List  in  our  practice,  and  we  can  truly  say  that  we 
could  not  wish  for  anything  belter.  It  has  saved  us  many 
times  its  cost,  and,  besides,  has  furnished  a  permanent  and 
pleasing  record  of  our  daily  work  during  the  years  that 
have  passed." — Canada  Medical  Record. 

Dear  Sirs : — We  received  the  Visiting  List  for  1S91.  It  is 
the  finest  of  all.  We  had  five  (5)  sent  us,  from  the  same 
number  of  firms,  and  must  acknowledge  it  is  the  smallest, 
neatest  and  most  compact,  as  any  physician  can  place  It  in 
his  side  pocket  with  ease,  while,  if  you  have  noticed  or 
seen  the  others,  they  will  require  the  tailor  to  enlarge  the 
coat  pocket.         Very  truly  yours, 

N.  W.  Mkdical  Journal, 
Minneapolis,  Minn. 

"  The  fact  that  this  Visiting  List  has  been  published  an- 
nually for  forty  years  is  sufficient  guarantee  of  its  excellence 
and  popularity.  In  addition  to  the  visiting  list  proper,  it 
contains  easily-accessible  suggestions  upon  many  of  the 
emergencies  that  may  arise  in  a  physician's  practice,  and 
when  he  is  too  far  from  home  to  learn  from  his  text-books 
the  antidote  for  a  poison  that  may  have  been  swallowed, 
or  the  proper  metliod  of  resuscitating  a  half-drowned  per- 
son. True,  he  should  know  these  things,  but  who  does  not 
occasionally  forget,  when  he  most  wishes  to  renirinbcr? 
There  are  also  dose-tables,  tables  of  the  nielric  sysli-m,  a 
list  of  new  remedies  for  i8<^,  rules  for  examining  urine,  a 
table  for  calculating  the  period  of  pregnancy,  ami  other 
equally  useful  information.  The  :irraiigcmcnt  for  entering 
patients,  visits,  consultations,  etc.,  is  exceeding  simple, 
and  the  whole  makes  a  thin,  compact,  an<l  easily-carried 
\o\\\\wi."— Medical  News,  I'hitada.,  January  jd,  iS<^i. 


*  *  P.  Blakiston,  Son  &  Co.  wish  to  announce  that  the  edition  for  1892  contains  several 
improvements  that  will,  without  making  -ny  radical  changes,  greatly  enhance  its  usefulness, 
compactness  and  durability. 


SURGERY. 

A  COMPLETE  PRACTICAL  TREATISE, 
WITH  SPECIAL  REFERENCE  TO  TREATMENT. 

BY  C.  W.  MANSELL  MOU  LLIN,  M.A.,  M.D..  OXON.. 

FELLOW  OF  THE  ROYAL  COLLEGE  OF  SURGEONS;  SURGEON  AND  LECTURER  ON  PHYSIOLOGY  TO  THE  LONDON  HOSPITAL,  ETC. 

ASSISTED    BY   VARIOUS    WRITERS    ON    SPECIAL   SUBJECTS. 

FIVE  HUNDRED  ILLUSTRATIONS. 

200    OF   TV^HICH   ARE    ORiaiNAL   \VITH    THIS   ^VORK. 


ROYAL  OCTAVO.    1190  PAGES. 
Royal  8vo.     Handsome  Cloth,  $7.00 ;  Leather,  Raised  Bands, 


s.oo. 


Extract  from  the  Preface. — "  Modern  Surgery  has  advanced  with  such  rapid  strides,  and  in  so  many 
different  directions,  that  it  is  almost  impossible  within  the  space  of  a  single  volume  to  give  more  than  an 
epitome  of  its  main  principles.  I  have  therefore  touched  but  lightly  upon  controversial  matters,  and  have 
endeavored  to  make  this  book  a  practical  one,  in  the  hope  that  it  may  be  of  greater  service  to  students  and 
general  practitioners.  With  this  object,  I  have  given  special  attention  to  the  question  of  Treatment ;  and  I 
have  included  under  the  head  of  each  organ  a  brief  description  of  the  malformations  to  which  it  is  liable,  and 
the  various  operations  that  may  be  performed  imder  it,  instead  of  relegating  them  to  chapters  by  themselves. 
The  General  Pathology  of  Surgical  Diseases  is  dealt  with  in  Part  I ;  that  of  Injuries  in  Part  II.  In  Part  III, 
the  Diseases  and  Injuries  of  Special  Structures  and  Organs  are  considered  more  fully.  Throughout,  I  have 
endeavored  to  enforce  the  idea  that  the  chief  aim  and  object  of  Surgery  at  the  present  day  is,  to  assist  the 
tissues  in  every  possible  way  in  their  struggle  against  disease. 

"  Of  the  five  hundred  illustrations,  nearly  two  hundred  were  (with  four  exceptions)  drawn  from  original 
specimens  by  my  brother,  Dr.  J.  A.  Mansell  Moulin  (to  whom  I  am  also  indebted  for  the  article  on  Diseases 
of  the  Female  Generative  Organs),  or  myself. 

"  I  have  to  express  my  thanks  to  Mr.  J.  Hutchinson,  junior,  for  his  chapters  on  Diseases  of  the  Skin  and 
Eye ;  to  Mr.  T.  Mark  Hovell,  for  that  on  Diseases  of  the  Ear  and  Larynx ;  and  to  Mr.  F.  S.  Eve,  for  that 
on  Tumors." 

OUTLINE  OF  CONTENTS. 


PART  I.— GENERAL  PATHOLOGY  OF  SURGICAL  DISEASES. 


I. 

II. 

III. 

IV. 

V. 

VI. 

VII. 

VIII. 

IX. 

X. 

XI. 

XII. 

XIII. 
XIV. 


Injury  and  Repair. 

Diseases  due  to  Non-infective  Organisms. 


Ill  &  IV.    Diseases  due  to  Infective  Organisms. 
V.    Tumors. 


PART  II.— GENERAL  PATHOLOGY  OF  INJURIES. 

The  General  Effects  of  Injury.  |  II.    The  Local  Effects  of  Injury. 

PART  III.— DISEASES  AND  INJURIES  OF  SPECIAL  STRUCTURES, 

Diseases  of  the  Skin. 

Injuries  and  Diseases  of  Blood-vessels. 

Injuries  and  Diseases  of  Lymphatics. 

Injuries  and  Diseases  of  Nerves. 

Injuries  and  Diseases  of  Muscles,  Tendons,  etc 

Injuries  and  Diseases  of  Bones  and  Joints. 

Injuries  and  Diseases  of  the  Head. 


Injuries  and  Diseases  of  the  Back, 

Injuries  and  Diseases  of  the  Eye. 

Injuries  and  Diseases  of  the  Face  and  Nose. 

Injuries  and  Diseases  of  the  Mouth  and  Jaws. 

Injuries  and  Diseases  of  the  Tongue,  Salivary 

Glands  and  Tonsils. 
Diseases  of  the  Ear  and  Larvnx. 
Injuries  and  Diseases  of  the  Neck  and  Throat. 


XV. 
XVI. 


Diseases  of  the  Thyroid. 

Injuries    and    Diseases    of   the    Pharynx    and 
CEsophagus. 
XVII.    Injuries  and  Diseases  of  the  Chest. 
XVIII.     Injuries  and  Diseases  of  the  Abdomen. 
XIX.    Injuries  and  Diseases  of  the  Rectum. 
XX.     Injuries  and  Diseases  of  the  Kidney. 
XXI.    Injuries  and  Diseases  of  the  Bladdei. 
XXII.    Diseases  of  the  Prostate. 

XXIII.  Injuries  and  Diseases  of  the  Urethra. 

XXIV.  Injuries  and  Diseases  of  the  Male  Organs. 
XXV.    Diseases  of  the  Female  Generative  Organs. 

XXVI.    Diseases  of  the  Breast. 
XXVII.    Amputations. 
XXVIII.    Anaesthetics, 


8@»  SAMPLE  PAGES  SENT  FREE  UPON  APPLICATION. 


HK701 

Gorgas 

Dental  medicine > 


G67 

1891 


